Analysis of focal lucent bony Analysis of focal lucent bony lesionlesion

Dr/Ahmed Bahnassy-M.B.CH.B.-Dr/Ahmed Bahnassy-M.B.CH.B.-M.D. Radiodiagnosis- AlexandriaM.D. Radiodiagnosis- Alexandria

FRCR-London.FRCR-London.

Study of lucent bony lesion depends Study of lucent bony lesion depends on:1.structural modification.on:1.structural modification.

2.periosteal reaction.2.periosteal reaction.3.tumour matrix.3.tumour matrix.4.tumoural extension.4.tumoural extension.

Structural modificationStructural modification

The bone reacts to any form of aggression The bone reacts to any form of aggression by either :by either :

1.stimulation of osteoclasts ..leading to 1.stimulation of osteoclasts ..leading to osteolysis.osteolysis.

2.stimulation of osteoblasts..leading to 2.stimulation of osteoblasts..leading to sclerosis.sclerosis.

Hence bony reaction to aggression can Hence bony reaction to aggression can be :be :

Lytic …Lytic …Sclerotic..Sclerotic..Or mixed.Or mixed.

OsteolysisOsteolysis

Analysis is based upon LODWICK criteria:Analysis is based upon LODWICK criteria:Type I :Geographical lesion .Type I :Geographical lesion .Type II :moth eaten lesion ..Type II :moth eaten lesion ..Type Iii :peremeative bony lesion.Type Iii :peremeative bony lesion.

Different types of osteolysisDifferent types of osteolysis::

Geographical bony lesionGeographical bony lesion

Focal lesion ,well defined, rounded, lobulated or Focal lesion ,well defined, rounded, lobulated or polygonalpolygonal

Can be divided to 3 sub types :Can be divided to 3 sub types : IA: sclerotic margins denoting slowly progressive IA: sclerotic margins denoting slowly progressive

lesion (bone cyst ,NOF ,Fibrous dysplasia)lesion (bone cyst ,NOF ,Fibrous dysplasia) IB: well defined ,non sclerotic margins ,denoting IB: well defined ,non sclerotic margins ,denoting

more rapid ,but still benign lesion (GCT, more rapid ,but still benign lesion (GCT, Chondromyxoid fibroma).Chondromyxoid fibroma).

IC :ill defined border denoting rapidly evoluting IC :ill defined border denoting rapidly evoluting lesion (Malignant or infectious)lesion (Malignant or infectious)

Moth eaten lesionMoth eaten lesion

Formed of small multiple bony lucencies Formed of small multiple bony lucencies destroying the cortex .destroying the cortex .

Corresponds to either infectious or Corresponds to either infectious or malignant lesion .malignant lesion .

Permeative lesionPermeative lesion

Cortical destruction by multiple bony Cortical destruction by multiple bony lucencies ,seen in tangential view .lucencies ,seen in tangential view .

Denoting a very aggressive process ..Denoting a very aggressive process ..Either malignant or infectious.Either malignant or infectious.

SclerosisSclerosis

Originates from :Originates from :1.Calcified tumor matrix.1.Calcified tumor matrix.2.Osseous necrosis( infarction ,aseptic 2.Osseous necrosis( infarction ,aseptic

necrosis,or sequestrum )necrosis,or sequestrum )

Mixed processesMixed processes

Geographical osteolyis ,surrounded by Geographical osteolyis ,surrounded by dense sclerosis:dense sclerosis:

Denotes slowly progressive lesion (osteoid Denotes slowly progressive lesion (osteoid osteoma,Osteoblastoma or chronic osteoma,Osteoblastoma or chronic

osteitis )osteitis )Complex ,disorganized lesion formed of Complex ,disorganized lesion formed of

lytic and sclerotic areas almost always lytic and sclerotic areas almost always with malignant or infectious pathologieswith malignant or infectious pathologies

Periosteal reactionPeriosteal reaction

Periosteal agression by a bony lesion (or Periosteal agression by a bony lesion (or less frequently soft tissue lesion )leads to less frequently soft tissue lesion )leads to osteogenesis from subperiosteal osteogenesis from subperiosteal osteoblasts .osteoblasts .

Manifested 2-4 weeks after beginning of Manifested 2-4 weeks after beginning of the process.the process.

Types of periosteal reactionTypes of periosteal reaction: :

1.Solid homogenous.1.Solid homogenous.2.Remodelled reaction.2.Remodelled reaction.3.continuous-separate from the cortex(uni 3.continuous-separate from the cortex(uni

or multi-lamellar).or multi-lamellar).4.Spiculated reaction (sun ray..brush 4.Spiculated reaction (sun ray..brush

border)border)5.discontinuous periosteal reaction.5.discontinuous periosteal reaction.

Periosteal reactionPeriosteal reaction

Periosteal reactionPeriosteal reaction

Analysis of tumour matrixAnalysis of tumour matrix

1.CT density .1.CT density .2.Aspect.2.Aspect.3.Vascularity .3.Vascularity .4.Locoregional extension.4.Locoregional extension. Osseous.Osseous. Soft Tissue.Soft Tissue. Distant.Distant.

Types of tumor matrixTypes of tumor matrix: :

Osseous matrix :geographic ,lytic ,CT Osseous matrix :geographic ,lytic ,CT =100-1000 HU,MRI =hypo in all =100-1000 HU,MRI =hypo in all sequencessequences

Cartilaginous matrix : lobulated with Cartilaginous matrix : lobulated with flocculant calcifications ring and C-shaped, flocculant calcifications ring and C-shaped, hypo T1,hyper T2 in MRI.hypo T1,hyper T2 in MRI.

Others :Cystic, Others :Cystic, fatty,homogenous ,heterogenous .fatty,homogenous ,heterogenous .

Loco-regional extensionLoco-regional extension

Diagnostic orientation :Diagnostic orientation :1.Age :after 40 years-infants.1.Age :after 40 years-infants.

2.Sex:2.Sex:3.Clinical presentation:3.Clinical presentation:

4.Location :long or flat bones-4.Location :long or flat bones-epi, meta or diaphyseal-central epi, meta or diaphyseal-central

or eccentricor eccentric..

Now some examplesNow some examples

Eccentric metaphyseal lucent lesion-Eccentric metaphyseal lucent lesion-GCTGCT

Meta-epiphyseal eccentric lucency Meta-epiphyseal eccentric lucency with sclerotic margins (NOF)with sclerotic margins (NOF)

Metaphyseal dense lesion-Metaphyseal dense lesion-EnchondromaEnchondroma

ChondromaChondroma

Eccentric metaphyseal lucency with Eccentric metaphyseal lucency with cortical destruction (Telangiectatic cortical destruction (Telangiectatic

osteosarcoma)osteosarcoma)

Epihyseal lucency with central Epihyseal lucency with central sclerosis (osteoid osteoma)sclerosis (osteoid osteoma)

Expanded-sclerosed vertebra Expanded-sclerosed vertebra (Paget disease )(Paget disease )

Vertebral body lucency (mets-GCT-Vertebral body lucency (mets-GCT-Active Paget )Active Paget )

Meta-diaphyseal sclerosis +ST Meta-diaphyseal sclerosis +ST swelling +periosteal reaction swelling +periosteal reaction

=Ewing sarcoma=Ewing sarcoma

Metaphyseal lesion with Metaphyseal lesion with densities and no cortical densities and no cortical

destructiondestruction

Still It was chondrosarcoma !Still It was chondrosarcoma !

Ollier diseaseOllier disease

ChondroblastomaChondroblastoma

OsteochondromaOsteochondroma

Chondromyxoid fibromaChondromyxoid fibroma

Chondromyxoid Chondromyxoid fibromafibroma

OsteoblastomaOsteoblastoma

Giant cell tumorGiant cell tumor

Ewing SarcomaEwing Sarcoma

Soft tissue swelling ..for MRISoft tissue swelling ..for MRI

Ewing SarcomaEwing Sarcoma

OsteosarcomaOsteosarcoma

ChondroChondro--

sarcomasarcoma

Multiple MyelomaMultiple Myeloma

Multiple MyelomaMultiple Myeloma

ChordomaChordoma

Aneurysmal Bone cystAneurysmal Bone cyst

ABC- CTABC- CT

Eosinophilic GranulomaEosinophilic Granuloma

Eosinophilic granulomaEosinophilic granuloma

AngiosracomaAngiosracoma

Thank you Thank you ……