Roentgen Signs of BONE DISEASE Flashcards
(34 cards)
Roentgen Signs of Bone Disease
CATEGORIZATION OF,,,,,,,,,,,, LESIONS!!
• By disease category‐ CATBITES X 8
1–C ongenital/dysplasia 2–A rthritis 3–T rauma 4–B lood/vascular 5– I nfection/inflammatory 6–T umor/tumor‐like 7–E ndocrine/metabolic 8–S oft tissue
KNOW WHAT CATBITE STANDS FOR!!
Roentgen Signs of Bone Disease
PRELIMINARY ANALYSIS: CLINICAL DATA
• Patient age • Patient sex • Ethnic/cultural background • History/chief complaint ******* This information will help rule in or out certain conditions
KNOW THESE 4
&
DEVELOP GOOD HABITS: SEARCH
PATTERN
• You need to consistently perform a complete search pattern on every radiographic study that you assess
• Use your ABC’S – Alignment – Bone – Cartilage (joint) – Soft tissue
Roentgen Signs of Bone Disease
IS THERE A LESION?? IF YES….
• You must determine if it is ____, joint, or soft
tissue in origin, and it must be described in a
systematic fashion
• This will direct you to a differential and in
some cases, a __________ diagnosis
• You must determine if the lesion appears
benign or _________
• You must indicate, on your report, the NEXT
step in evaluation, treatment, and referral.
bone
specific
aggressive
Roentgen Signs of Bone Disease
A LIST OF THINGS TO ASSESS X 14
• Once a lesion or lesions involving bone have
been identified, there are many variables that
can be assessed:
- -Skeletal location
- Behavior of the lesion
- -Position within the bone
- Matrix
- -Site of origin
- Periosteal response
- -Shape
- -Soft tissue changes
- -Size
- -Number of lesions
- -Margination
- Symmetry in the body
- -Cortical integrity
- -Systems involved
KNOW CUZ…HERE THEY COME!!
Roentgen Signs of Bone Disease
THE ANALYSIS / DESCRIPTION OF THE LESION
1— Skeletal LOCATION
– in what part of the skeleton is it located
(spine, skull, humerus)
2—Position WITHIN the bone
– is it metaphyseal, diaphyseal, etc.
– is it in the vertebral ____, pedicle, etc.
– is it concentric or eccentric??
body
Roentgen Signs of Bone Disease
ANALYSIS / DESCRIPTION OF THE LESION
3— _________ of origin
– is it medullary, cortical, periosteal, extraosseous, or a
combination.
4— _______ (morphology)
– is it ROUND, oval, scalloped, pedunculated,
sessile, serpiginous, etc.
SITE
SHAPE
Roentgen Signs of Bone Disease
ANALYSIS / DESCRIPTION OF THE LESION
5— SIZE
– if possible, __________ the lesion
– some lesions are distinguished primarily by their size
6— MARGINATION
– __________= usually poorly defined
(indistinct, wide zone of transition)
–________ = usually well defined
(sharp, short zone of transition)
measure
]
aggressive
benign
Roentgen Signs of Bone Disease
ANALYSIS / DESCRIPTION OF THE LESION
7— Cortical integrity
EX• THINNING‐ focal: from a medullary or soft tissue lesion; diffuse: from osteoporosis
EX• THICKENING‐ variety of causes
EX• EXPANSION‐ typically described as
“______ _______”, especially if septated
EX• ______________ ‐ usually a sign of aggression
• CORTICAL interruption= ____________
soap bubbly
DESTRUCTION
fracture
*******MUST SEE SLIDE 18!!!
Roentgen Signs of Bone Disease
ANALYSIS / DESCRIPTION OF THE LESION
8— NUMBER of lesions
– multiple lesions most common in ________ conditions, dysplasia, metastasis.
– this finding alone does NOT indicate the nature of the pathology!!
9— SYMMETRY of lesions
– symmetry tends to lead ______ from tumors and trauma, and focus into a systemic or metabolic processes
systemic
AWAY
Roentgen Signs of Bone Disease
ANALYSIS / DESCRIPTION OF THE LESION
10— SYSTEMS involved
– is the condition _________ to the bones, or are there findings in the viscera, brain, joints, or other soft tissues?
isolated
Roentgen Signs of Bone Disease
ANALYSIS / DESCRIPTION OF THE LESION
11— OsteoLYTIC/LUCENT lesions
– both terms indicate a focal DECREASE in bone density
– osteoLYTIC is usually reserved for _______ lesions,
–lucent for ___________;
but there is no specific rule
– changes due to pressure erosion/osteoclastic activity‐ NOT direct tumor LYSIS
aggressive
benign
Roentgen Signs of Bone Disease
ANALYSIS / DESCRIPTION OF THE LESION
12— GEOGRAPHIC lesions
– lucent destruction of bone, usually from a
non‐aggressive lesion
– lesions are usually over 1‐cm in diameter, and have sharp borders
– usually solitary, but can be __________
– may be expansile or ___________
multiple
non‐expansile
Roentgen Signs of Bone Disease
ANALYSIS / DESCRIPTION OF THE LESION
13--- Moth‐eaten – invariably due to an aggressive lesion – focal, \_\_\_\_\_\_\_\_\_ and ill‐ defined areas of lytic bone destruction – lytic foci are of \_\_\_\_\_\_\_\_ size
irregular
varying
Roentgen Signs of Bone Disease
ANALYSIS / DESCRIPTION OF THE LESION
14— Permeative
– invariably due to an aggressive lesion, usually a TUMOR
– focal, pin‐point areas of lytic destruction
– can coalesce to form a ______________ pattern
moth‐eaten
Roentgen Signs of Bone Disease
ANALYSIS / DESCRIPTION OF THE LESION
15— OsteoBLASTIC/SCLEROTIC lesions
– both terms indicate an ________ in bone density
– osteoBLASTIC is usually reserved for _________ lesions, sclerotic for benign; but there is no specific rule
– due to bone reaction to the _________, or actual
bone production
16— Mixed lesions
– a combination of most any of the above
increase
aggressive
tumor
Roentgen Signs of Bone Disease
ANALYSIS / DESCRIPTION OF THE LESION
17--- MATRIX of the lesion – The dominate internal \_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_ in a lesion – Often there are radiographic findings that can give a clue to what the matrix is – 5 basic types of matrices • Fat • Cartilage • Bone • Fibrous • Cystic / fluid
extracellular substance
Roentgen Signs of Bone Disease
ANALYSIS / DESCRIPTION OF THE LESION
17— Matrix
1– FAT
• fat density lesion if in the _______ _________.
• bone lesions tend to be LUCENT, and like to ossify/Ca++
soft tissues
Roentgen Signs of Bone Disease
ANALYSIS / DESCRIPTION OF THE LESION
17—-MATRIX CONT…..
2– CARTILAGE
• typically lucent/lytic
• cartilaginous lesions usually demonstrate some type of
CALCIFICATION
• different TYPES of calcification seen =
– ____________: focal, small spots, relatively uniform
– ____________: larger, variable size and density, confluence of stippled Ca++
– ____________: thin, curvilinear Ca++, typically seen
in aggressive lesions
stippled
flocculent
arc & ring (C & O)
MUST SEE SLIDE 36!!!
Roentgen Signs of Bone Disease
ANALYSIS / DESCRIPTION OF THE LESION
17— MATRIX CONT…
3-– OSSEOUS
• can have a lucent, sclerotic, or __________ appearance
• classic lesions are densely radiopaque, rather than the focal patterns seen with cartilage based calcification
mixed
Roentgen Signs of Bone Disease
ANALYSIS / DESCRIPTION OF THE LESION
17—MATRIX CONT..
4—– FIBROUS
• see hazy “________ ______”, OR “_____ _____”, OR “smudged” appearance
• can be LUCENT OR LYTIC, similar to cartilage‐ based lesions
• Ca+ uncommon
ground glass
frosted mug
Roentgen Signs of Bone Disease
ANALYSIS / DESCRIPTION OF THE LESION
18—MATRIX CONT..
5—– Cystic
• NOT a true tissue‐ based division
• includes most other ______ lesions that are at least mildly expansile and have a fluid component.
benign
Roentgen Signs of Bone Disease
ANALYSIS / DESCRIPTION OF THE LESION
19— Periosteal reactions
A– Almost always considered evidence of an _________ process
B– How aggressive depends on the pattern
C– 4 basic patterns • Solid • Laminated • Spiculated – Sunburst • \_\_\_\_\_ \_\_\_\_\_\_\_\_\_
aggressive
Codman’s triangle
Roentgen Signs of Bone Disease
ANALYSIS / DESCRIPTION OF THE LESION
19—Periosteal reaction CONT.,.
1– Solid
• single layer, typically attached to the _______
• indicates a ________ or SLOW growing lesion
cortex
benign
Roentgen Signs of Bone Disease
ANALYSIS / DESCRIPTION OF THE LESION
19—Periosteal reaction CONT.,.
2— – Laminated (_____ _______)
• one or more layers, NOT fully connected to the cortex
• usually indicates a more __________ lesion
onion skin
aggressive
