Tumor Imaging & Cystic Lesions of Bone

Question 1

When analyzing lesions, one must consider:

Answer 1

• Age
• Clinical presentation
• Radiographic characteristics

Question 2

L’PoDZ PMS

What are five radiographic characteristics to analyze a lesion?

Answer 2

• Location
• Pattern of destruction
• Zone of transition
• Periosteal reaction
• Soft tissue mass

Question 3

What are some descriptions for where in the bone a lesion has occurred?

Answer 3

• Epiphysis/apophysis, metaphysis, diaphysis
• Central (eucentric)/eccentric

Question 4

What are the osteolytic patterns of destruction?

Answer 4

• Permeative
• Moth-eaten
• Geographic

Question 5

What are the osteoblastic patterns of destruction?

Answer 5

• Focal
• Multifocal
• Diffuse

Question 6

What is a permeative pattern of destruction?

Answer 6

Multiple endosteal radiolucent small lesions with a poor zone of transition
(osteolytic)

Question 7

What is a moth-eaten pattern of destruction?

Answer 7

Multiple moderately sized endosteal radiolucent lesions with a poor zone of transition
(osteolytic)

Question 8

What is a geographic pattern of destruction?

Answer 8

Lesion with sharply defined border and narrow zone of transition between normal and pathologic bone
(osteolytic)

Question 9

What is a focal pattern of destruction?

Answer 9

Increased osteoblastic activity in one location appearing radiopaque

Question 10

What is a multifocal pattern of destruction?

Answer 10

Multiple/many locations of increased osteoblastic activity appearing roadiopaque

Question 11

What is a diffuse pattern of destruction?

Answer 11

Multiple bones (ie. spine, pelvis) increase in bone density (sclerotic) without pinpoint locations of lesions
(osteoblastic)

Question 12

What is the zone of transition?

Answer 12

Interface between normal bone and diseased bone

Question 13

How might the zone of transition be described?

Answer 13

Long or short; wide or narrow

Question 14

If prostate cancer has caused the spine and pelvis to increase bone densities, what pattern of destruction has occurred?

Answer 14

Diffuse osteoblastic destruction (metastasis)

Question 15

reactive bone formation

Intramembranous bone is formed in response to ___

Answer 15

stress on bone or soft tissue

Question 16

reactive bone formation

Once stimulus lifts the periosteum, what is the result?

Answer 16

Intramembranous bone formation

Question 17

reactive bone formation

If the periosteum has lifted, which types of bone will be made during intramembranous bone formation?

Answer 17

Woven or lamellar

Question 18

What is the term for the process of lifting the periosteum and intramembranous bone formation?

Answer 18

Periosteal reaction

Question 19

What are the types of periosteal reaction?

Answer 19

• Solid
• Laminated
• Spiculated
• Codman’s triangle

Question 20

Can the periosteal reaction involve the endosteum?

Answer 20

Yes

Question 21

How does a solid periosteal reaction progress?

Answer 21

• Slow growing
• Typically non-aggressive
• Periosteum is lifted slowly and fills completely

Question 22

A patient has experienced a fatigue fracture causing bone hemorrhage. Their radiographs now display a periosteal reaction that has filled completely.
What type of periosteal reaction has occurred?

Answer 22

Solid periosteal reaction

Question 23

A patient is known to have osteoid osteoma, a benign bone tumor. Their radiographs display a slow growing, filled in periosteal reaction.
What type of periosteal reaction has occurred?

Answer 23

Solid periosteal reaction

Question 24

What are some causes of solid periosteal reaction?

Answer 24

• Bone hemorrhage (ie. fatigue fractures)
• Benign bone tumors (ie. osteoid osteoma)

Question 25

Which periosteal reaction is an aggressive process of lifting, stopping, and lifting the periosteum again?

Answer 25

Laminated periosteal reaction

Question 26

What is a laminated periosteal reaction?

Answer 26

* Aggressive process * Lifts periosteum, stops, lifts again, etc. * Lays down bone during rest phase

Question 27

Which periosteal reaction is an aggressive process where periosteum is lifted rapidly?

Answer 27

Spiculated periosteal reaction

Question 28

A patient's radiograph evidences bone growth along Sharpey fibers with a "hair on end"/"sunburst" appearance What type of periosteal reaction has occurred?

Answer 28

Spiculated periosteal reaction

Question 29

How does a spiculated periosteal reaction appear on a radiograph?

Answer 29

* Bone growth along the Sharpey fibers * "Hair on end"/"sunburst" appearance

Question 30

Which periosteal reaction is an aggressive process extending beyond bone (into unaffected bone) rapidly?

Answer 30

Codman triangle periosteal reaction

Question 31

What is Codman triangle periosteal reaction?

Answer 31

* Aggressive pattern * Extends beyond bone rapidly * Strips periosteum away from adjacent uninvolved bone

Question 32

What are five patterns of matrix calcification?

Answer 32

1. No calcification (can't tell on purely lytic lesions) 2. Target calcification 3. Stippled calcification 4. Blastic lesion 5. Ground glass

Question 33

Which matrix calcification occurs in fat?

Answer 33

Target calcification

Question 34

Which matrix calcification occurs in cartilage?

Answer 34

Stippled calcification

Question 35

Which matrix calcification occurs in osseous tissue?

Answer 35

Blastic lesion

Question 36

Which matrix calcification occurs in fibrous tissue?

Answer 36

Ground glass

Question 37

#matrix calcification Where does target calcification occur?

Answer 37

Fat

Question 38

#matrix calcification Where does stippled calcification occur?

Answer 38

Cartilage

Question 39

#matrix calcification Where does a blastic lesion occur?

Answer 39

Osseous structures

Question 40

#matrix calcification Where does ground glass calcification occur?

Answer 40

Fibrous tissues

Question 41

If there is an aggressive periosteal reaction, will there be a mass extending beyond bone into soft tissue?

Answer 41

Yes

Question 42

If you can see displacement of facial planes, will there be a mass extending beyond bone into soft tissue?

Answer 42

Yes