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Kenneth Buckwalter, M.D.Kenneth Buckwalter, M.D.Indiana UniversityIndiana University

kbuckwal@iupui.edukbuckwal@iupui.edu

(31! "#$1%3(31! "#$1%3

&adi'l'y ') B'ne *u+'rs&adi'l'y ') B'ne *u+'rs

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utlineutline

- 'rk$up and &adi'l'ic assess+ent'rk$up and &adi'l'ic assess+ent

- /ppr'ach/ppr'ach

0 'r+al b'ne anat'+y'r+al b'ne anat'+y

0 &adi'raphic /nalysis&adi'raphic /nalysis

- 2'cati'n2'cati'n

- MarinsMarins

- eri'steal reacti'neri'steal reacti'n

- Matri4Matri4- 54a+ples54a+ples

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'rk$up'rk$up

- 6ist'ry6ist'ry

0/e is critical./e is critical.

0 7+'ker87+'ker8

0 Malinancy8Malinancy8

- hysical e4a+inati'nhysical e4a+inati'n

0 Breast +ass8Breast +ass8

- 9''d radi'raphs ') a))ected rei'n9''d radi'raphs ') a))ected rei'n0 " views +ini+u+" views +ini+u+

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Multiple vs. 7'litaryMultiple vs. 7'litary

- MultipleMultiple

0 +etastatic+etastatic

0 c'nenitalc'nenital

- )ibr'us dysplasia)ibr'us dysplasia0 ac:uiredac:uired

- aetaet

- 7'litary7'litary

0 +etastatic+etastatic0 pri+ary b'ne tu+'r, +alinant 'r beninpri+ary b'ne tu+'r, +alinant 'r benin

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MultipleMultiple

- ;';'

0 kn'wn +alinancy8kn'wn +alinancy8

0 +yel'+a, et 75+yel'+a, et 75

0 'therwise, d' +etastatic w'rk$up'therwise, d' +etastatic w'rk$up- child t' early adultchild t' early adult

0 kn'wn +alinancy8kn'wn +alinancy8

0 598598

0 p'ly'st'tic )ibr'us dysplasia8p'ly'st'tic )ibr'us dysplasia80 'therwise, d' +etastatic w'rk$up'therwise, d' +etastatic w'rk$up

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7'litary7'litary

- /ressive radi'raphic appearance/ressive radi'raphic appearance

0 b'ne scan t' stae and veri)y s'litary natureb'ne scan t' stae and veri)y s'litary nature

0 +etastatic w'rk$up+etastatic w'rk$up

- baseline ?&baseline ?&

- spiral ?* )'r pul+'nary n'dulesspiral ?* )'r pul+'nary n'dules

- 7tain )'r surery7tain )'r surery

0cr'ss$secti'nal i+ainA ?* 'r M&cr'ss$secti'nal i+ainA ?* 'r M&

- eed tissue bi'psyeed tissue bi'psy

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Bi'psyBi'psy

- 'bvi'us super)icial +ass, blind bi'psy'bvi'us super)icial +ass, blind bi'psy

- tissue c'+part+ents +ust n't betissue c'+part+ents +ust n't bec'nta+inatedc'nta+inated

0 Bi'psy sh'uld be d'ne in c'nsultati'n with aBi'psy sh'uld be d'ne in c'nsultati'n with atu+'r sure'n.tu+'r sure'n.

- skinny needle +'st help)ul with +etastaticskinny needle +'st help)ul with +etastaticdiseasedisease

- c're best )'r pri+ary tu+'rc're best )'r pri+ary tu+'r

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?r'ss$secti'nal i+ain?r'ss$secti'nal i+ain

- ictures are pretty, butictures are pretty, but diagnosis establisheddiagnosis established

at histologyat histology

- M&I best )'r +'st tu+'rsM&I best )'r +'st tu+'rs

0 'pti+al results at sites with e4perience'pti+al results at sites with e4perience

- &'le ') ?* li+ited&'le ') ?* li+ited

0 +ay assist in assessin tu+'r +atri4+ay assist in assessin tu+'r +atri4

0 use)ul in directin bi'psyuse)ul in directin bi'psy

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'r+al /nat'+y'r+al /nat'+y

epiphysis

metaphysisdiaphysis

physis

childhoodchildhood adultadult

cortex

medullarmedullar

spacespace

medullarmedullar

spacespace

physeal scarphyseal scar

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6'w are B'ne *u+'rs6'w are B'ne *u+'rs

2ike &eal 5state82ike &eal 5state8

2'cati'n

2'cati'n

2'cati'n

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2'cati'n2'cati'n

- 2'cati'n and ae ') patient +'st i+p'rtant2'cati'n and ae ') patient +'st i+p'rtant

para+eters in classi)yin a pri+ary b'nepara+eters in classi)yin a pri+ary b'ne

tu+'r.tu+'r.

- 7i+ple t' deter+ine )r'+ plain radi'raphs.7i+ple t' deter+ine )r'+ plain radi'raphs.

2 i

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2'cati'n2'cati'n

Rad Clin N ARad Clin N A

Dec 1981Dec 1981

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&eacti'n ') b'ne t' tu+'r&eacti'n ') b'ne t' tu+'r

- 2i+ited resp'nses ') b'ne2i+ited resp'nses ') b'ne

destructiondestructionAA lysis (lucency!lysis (lucency!

reactionreactionAA scler'sisscler'sis

remodelingremodelingAA peri'steal reacti'nperi'steal reacti'n

- &ate ') r'wth deter+ines b'ne resp'nse&ate ') r'wth deter+ines b'ne resp'nse

0 sl'w pr'ressi'n, scler'sis prevailssl'w pr'ressi'n, scler'sis prevails

0 rapid pr'ressi'n, destructi'n prevailsrapid pr'ressi'n, destructi'n prevails

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&eacti'n ') b'ne t' tu+'r&eacti'n ') b'ne t' tu+'r

- Marin between tu+'r and native b'ne isMarin between tu+'r and native b'ne is

visible 'n the plain radi'raph.visible 'n the plain radi'raph.

- 7l'wly pr'ressive pr'cess is Cwalled$')) by7l'wly pr'ressive pr'cess is Cwalled$')) by

native b'ne, pr'ducin distinct +arins.native b'ne, pr'ducin distinct +arins.

- &apidly pr'ressive pr'cess destr'ys b'ne,&apidly pr'ressive pr'cess destr'ys b'ne,

pr'ducin indistinct +arins.pr'ducin indistinct +arins.

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&adi'raphic Marins&adi'raphic Marins

- Marin types 1/, 1B, 1?, ", and 3Marin types 1/, 1B, 1?, ", and 3

0 least aressive 1/, t' +'st aressive 3least aressive 1/, t' +'st aressive 3

- /ressive lesi'ns destr'y b'ne./ressive lesi'ns destr'y b'ne.

- /ressiveness increases likelih''d ')/ressiveness increases likelih''d ')

+alinancy.+alinancy.

0 BU*, n't all aressive pr'cesses are +alinant.BU*, n't all aressive pr'cesses are +alinant.

0/D, n't all +alinant diseases are aressive./D, n't all +alinant diseases are aressive.

M i 1/ 1B 1?M i 1/ 1B 1?

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MarinsA 1/,1B,1?MarinsA 1/,1B,1?

increasin aressivenessRad Clin N Am,Rad Clin N Am,

Dec 1981Dec 1981

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1/A scler'tic +arin1/A scler'tic +arin

- si+ple cyst (UB?!si+ple cyst (UB?!

- ench'ndr'+aench'ndr'+a

- ED > EED > E

- ch'ndr'blast'+ach'ndr'blast'+a- 9?*9?*

- ch'ndr'sarc'+a (rare!ch'ndr'sarc'+a (rare!

- ME6 (rare!ME6 (rare!

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1BA well$de)ined, n'n$scler'tic1BA well$de)ined, n'n$scler'tic

- 9?*9?*

- ench'ndr'+aench'ndr'+a

- ch'ndr'blast'+ach'ndr'blast'+a

- +yel'+a, +etastatsis+yel'+a, +etastatsis- ?ME?ME

- EDED

- ch'ndr'sarc'+ach'ndr'sarc'+a

- ME6ME6

Rad Clin N Am,Rad Clin N Am,

Dec 1981Dec 1981

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1?A lytic, ill$de)ined +arins1?A lytic, ill$de)ined +arins

- ch'ndr'sarc'+ach'ndr'sarc'+a

- ME6ME6

- 'ste'sarc'+a'ste'sarc'+a

- 9?*9?*- +etastasis+etastasis

- in)ecti'nin)ecti'n

- 5959

- ly+ph'+aly+ph'+a

Rad Clin N Am,Rad Clin N Am,

Dec 1981Dec 1981

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"A C+'theaten"A C+'theaten

- +yel'+a, +etastases+yel'+a, +etastases

- in)ecti'nin)ecti'n

- 5959

- 'ste'sarc'+a'ste'sarc'+a- ch'ndr'sarc'+ach'ndr'sarc'+a

- ly+ph'+aly+ph'+a

Rad Clin N Am,Rad Clin N Am,

Dec 1981Dec 1981

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3A Cper+eative3A Cper+eative

- 5win5win

- 5959

- in)ecti'nin)ecti'n

- +yel'+a, +etastasis+yel'+a, +etastasis- ly+ph'+aly+ph'+a

- 'ste'sarc'+a'ste'sarc'+a

Rad Clin N Am,Rad Clin N Am,

Dec 1981Dec 1981

*ypes ')ypes '

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*ypes ')ypes 'eri'stealeri'steal

&eacti'n&eacti'n

Rad Clin N Am,Rad Clin N Am,

Dec 1981Dec 1981

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eri'steal &eacti'neri'steal &eacti'n

- 2i+ited use)ulness2i+ited use)ulness- *hick, uninterrupted*hick, uninterrupted

0 l'n standin pr'cess, ')ten n'n$aressivel'n standin pr'cess, ')ten n'n$aressive

- stress )racturestress )racture

- chr'nic in)ecti'nchr'nic in)ecti'n

- 'ste'id 'ste'+a'ste'id 'ste'+a

- 7piculated, la+ellated7piculated, la+ellated

0 aressive pr'cessaressive pr'cess0 tu+'r likelytu+'r likely

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?'d+an *rianle?'d+an *rianle

peri'steal reacti'n

tu+'r

advancin tu+'r +arin

destr'ys peri'steal new

b'ne be)'re it 'ssi)ies

?'d+an

*rianle

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*u+'r Matri4*u+'r Matri4

- CCMatri4 is the internal tissue ') the tu+'rMatri4 is the internal tissue ') the tu+'r

- M'st tu+'r +atri4 is s')t tissue in nature.M'st tu+'r +atri4 is s')t tissue in nature.

0 &adi'lucent (lytic! 'n 4$ray&adi'lucent (lytic! 'n 4$ray

- ?artilae +atri4?artilae +atri4

0 calci)ied rins, arcs, d'ts (stippled!calci)ied rins, arcs, d'ts (stippled!

0 ench'ndr'+a, ch'ndr'blast'+a, ch'ndr'sarc'+aench'ndr'+a, ch'ndr'blast'+a, ch'ndr'sarc'+a

- ssi)ic +atri4ssi)ic +atri40 'ste'sarc'+a'ste'sarc'+a

Matri4Matri4

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Matri4Matri4

Rad Clin N Am,Rad Clin N Am,

Dec 1981Dec 1981

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54a+ples54a+ples

54a+ple 1

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/95 13

2'cati'n +etadiaphys

Mar(ins 1/$1B

eri'steal &eacti'n n'ne

Matri4 n'ne

ther trabecular stru

D@ UB?

54a+ple 1

54a+ple "

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p

54a+ple "

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/95 adult

2'cati'n +etaphysis

Mar(ins 1B

eri'steal &eacti'n n'ne

Matri4 n'nether )4

D@ /B?

p

54a+ple 3A 13 y>' with knee pain

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54a+ple 3A 13 y>' with knee pain

54a+ple 3

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/95 13

2'cati'n epiphyseal

Mar(ins 1B

eri'steal &eacti'n n'ne

Matri4 n'ne

ther

D@ ch'ndr'blast'

54a+ple 3

54a+ple #A #; y>' with knee pain

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p y p

54a+ple #

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p

/95 #;

2'cati'n +etaphysis

Mar(ins 1B

eri'steal &eacti'n n'ne

Matri4 n'ne

ther epi inv'lve+e

D@ 9?*

54a+ple #F, 3; y>' E, 9?*

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54a+ple ;

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/95 GG

2'cati'n diaphyseal

Mar(ins 1/

eri'steal &eacti'n +ini+al, thic

Matri4 n'ne

ther "nd lesi'n

D@ waitH..

p

54a+ple ;

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p

/95 GG

2'cati'n diaphyseal

Mar(ins "

eri'steal &eacti'n n'ne

Matri4 n'ne

ther

D@ waitH..

54a+ple ;

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/95 GG

2'cati'n )lat b'ne

Mar(ins 1B

eri'steal &eacti'n n'ne

Matri4 n'ne

ther +ultiple

D@ +yel'+a

54a+ple GA 1# y>' with claudicati'n

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54a+ple G

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54a+ple G

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/95 1#

2'cati'n +etaphysis

Mar(ins 1B

eri'steal &eacti'n n'ne

Matri4 +ature b'ne

ther claudicatIn

D@ e4'st'sis

54a+ple A "; y>' w'+an with knee pain

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54a+ple

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54a+ple

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/95 ";

2'cati'n +etaphysis

Marins 1/

eri'steal &eacti'n n'ne

Matri4 8ther +ultiple

D E

54a+ple %A #; y>' with thih pain

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54a+ple %

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/95 #;

2'cati'n diaphysis

Mar(ins 1B

eri'steal &eacti'n thick

Matri4 )aintther

D@ 'ste'id 'ste'+

54a+ple J

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/95 1"

2'cati'n diaphysis

Mar(ins 3

eri'steal &eacti'n la+ellated

Matri4 n'nether

D@ 5win(

54a+ple J

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C'ni'n$skin

54a+ple 1

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54a+ple 1

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/95 1G

2'cati'n diaphysis

Mar(ins 3

eri'steal &eacti'n spiculated

Matri4 b'nether )4

D@ 'ste'sarc'+

54a+ple 1

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/95 "