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Flashcards in Radiologic approach to bone tumors Deck (11):

Role of the radiologist

-To work w/ orthopedic oncologist, pathologist to Dx and Rx the pt
-DDx of pathologist and radiologist may be identical


T/F questions 1

-CT guided bone biopsy shouldn't always be obtained thru most direct approach (can introduce tumor cells into new compartments)
-MRI isn't the most useful in Dxing bone tumors (X-rays are)
-Xrays aren't the most useful in revealing extent of disease (MRIs are)


Ways to Dx bone tumors on xrays

-Most bone tumors have predilection for a specific age group
-Number of lesions
-Type of bone destruction
-Borders of the lesion


Bone destruction/borders

-From least to most aggressive
-Type1 (geographic): complete bony destruction
-Type2 (moth eaten): multiple clustered foci of bone destruction
-Type3 (permeative, ewing sarcoma): multiple ill-defined foci of bony destruction


Borders of lesions

-Blastic/sclerotic lesions are circumscribed
-Found on X-rays, not MRIs
-From least to most aggressive
-1A margin: sharp demarcation + sclerosis
-1B margin: sharp demarcation w/o sclerosis
-1C margin: ill-defined region, interface w/ bone


T/F questions 2

-Moth eaten pattern of bone destruction is aggressive
-Xrays are used to see the borders of lesions
-Geographic destruction pattern + sclerotic margin means not aggressive


Sites of bone tumors

-Some tumors arise in specific bones and/or specific site of bones
-Chondroblastoma prefers the epiphysis of long bones (produces sclerotic rim)
-Adamantinoma and osteofibrous dysplasia: tibia


Periosteal reactions

-Uninterrupted (continuous): cortical thickening, indicates benign process
-Lamellated (onion-skin): many layers of cortical thickening, indicated intermediate aggressive process (waxes and wanes)
-Interrupted (sunburst, frayed ends): most aggressive types
-Codman's triangle: elevation of the periosteum away from cortex, very aggressive


Matrix mineralization

-Types of mineralized (calcified) matrix indicates the tumor
-Osteoid: fluffy and cloud-like
-Chondroid: a bunch of clustered rings and arcs


Soft tissue mass

-Soft tissue components suggest malignant process
-Ex: osteosarcoma, ewing sarcoma, lymphoma


T/F questions 3

-Locations of lesion do help predict Dx
-Chondroid matrix mineralization is not fluffy and cloud-like, but many rings/arcs (osteoid matrix is fluffy and cloud-like)
-Sunburst periosteal rxn is very aggressive
-Presence of soft tissue masses suggests malignant process
-A pt w/ impending pathologic fracture should be non-weight bearing