RADIO 250 [8] LEC 09 Musculoskeletal Radiology

7/23/2019 RADIO 250 [8] LEC 09 Musculoskeletal Radiology

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TOPIC OUTLINE

I. Bone TumorsA. ModalitiesB. Diagnostic Criteria

II. Summary

Transers Note:Dr. Galsim didnt give us a copy of his T so !e used the pictures

from the "#$% &uddy CD files and from the internet. 'appy studying( )*

Legend:+rom TMentioned by lecturer

I. BONE TUMORS

Seldom encountered by clinicians

Important to recognize them in future clinical practice

A. MODALITIES

Radiographic findings may not allow precise diagnosis

Provide reliable information on aggressiveness or rate of growth of

bone tumors

Aggressivemalignant; non-aggressivebenign; ecept!

o Aneurysmal bone cyst " osteomyelitis # aggressive but benign

o Ameloblastoma # non-aggressive but malignant

X-RAY

$onventional %& imaging modality

Sensitive techni'ue

Assesses the aggressivenessof the lesion( based on certain criteria

given )e* non-aggressive lesions are benign+

$annot provide a histological diagnosis

,. of bone matri must be destroyed to be observed

ULTRASOUND

/sed for 0oint diseases )e* effusion( edema+

1ot very useful unless with total destruction of the bone corte

2ften used in MS3 for assessment of muscles, tendons, & soft

tissue

CT

/sed for cortical lesions

&etermine calcifiedlesions )appear hyperdense+

/seful for determining the etent of the tumor( for its staging( and for

detecting metastasis )contiguous or distal+

MRI

/sed for marrow, medullary cavity lesions, & soft tissue

4ives superior soft tissue resolution

5i6e $7( useful for determining tumor etent( staging( and metastasis

BONE SCAN

Assesses bone metastasis

/nli6e plain radiographs( bone marrow destruction can be as low as ,

to %. to be detected &etermines level of metabolic activity

8ery sensitive but non-specific

o 9alse positive! degenerative( superimposed inflammatory process( or

from previous thoracotomy

PET

Able to assess functionality

:pensive( but when combined with CT/MRI(etent or status of the

lesion becomes easily defined

B. DIANOSTIC CRITERIA

AE

,ac- dei-en

o Bone radiologisto valuated /### malignant &one tumors0 !hich could &e d!agnosed

"orre"t#$ %&' o( t)e t!*e1ust &y using the patients age

Infant Metastat!" ne+ro,#asto*a

$stto "nddecade !ings tumor

"ndto 2rddecade 3steosarcoma

/# years old and a&ove Metastatic carcinoma0 multiplemyeloma0 and chondrosarcoma

Ta,#e . Most common &one tumors &ased on age groups.

LOCATION IN LON BONE

Parts of a long bone

o :piphysis # one end of the long bone

o

Metaphysis # growth plate regiono &iaphysis # shaft

o 2thers! epiphyseal plate( apophysis( articular cartilage

E!)$s!s 9our most common conditions!

Chondro&lastoma 4!ith calcification in matri5* 6

child

Giant cell tumors 6 adult

2steomyelitis # fungus( 7

Aneurysmal bone cysts


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Lec 09: Musculoskeleal Radiology

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0!g+re 1.Metaphyseal tumor 4&ut e5tends to the diaphysis0 so more ofmetadiaphysealinvolvement*. ointed structures are osteosar"o*as0

e5amples of cloudy0 amorphous matrices.

0!g+re 2.D!a)$sea#involvement. E3!ngs sar"o*a in

young patient0 then *+#t!#e *$e#o*a6 older patients 4left*.En")ondro*a!ith pathologic fracture 4right*.

TUMOR MARINS

attern of &one destruction:;one of transition

Most relia&le plain film indicator for aggressive vs. nonarro! =3T 6 !ell


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0!g+re 7. ermeative &one lesion !ith a !ide =3T. 8o!er ;one appearsmore lucent than upper.

PERIOSTEAL NE8 BONE 0ORMATION

>hen there is a tumor or infection( the endosteum and periosteum reactand try to contain the lesion*

0!g+re &. Types of periosteal reaction from left to right) 4$* 8amellar0 4"*8aminated:8ayered0 42* Sun&urst0 and 4/* Codmans Triangle.

$. 8amellar

Most common form of bone formation

@ith single layer of ne! &one formation

niform thic-ness 4$mm* and density

'allmar- of a &enign lesion)no surgical intervention necessary+

o :* 1on-ossifying fibroma # benign( should not be touched

o :* $hronic osteomyelitis that?s healed

o @owever( osteoid osteoma is a benign lesion( but re'uires

interventione should 6now how to differentiate between osteoid and chondroid*

$. Chondroid

unctate0 popcorn


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0!g+re 4. Chondroid matri5. 'igh grade chondrosarcoma of the left iliac&one. Soft tissue e5tension seen on a5ial T"

0!g+re 5. Chondroid matri5.

". 3steoid

Cloudli-e or amorphous 4chal6-li6e appearance*

1o particular shape

May also present with calcifications

0!g+re 6. 3steoid matri5 in osteosarcoma 4left*. 3steoid osteoma 4right*.

0!g+re %. Intramedullary osteosarcoma of distal femur !ith large softtissue mass e5hi&iting classic osteoid matri5.

II. SUMMARY

Eno!ledge of the radiologic diagnostic criteria for &one tumors !ouldena&le a physician to accurately characteri;e the lesion0 determine itsaggressiveness0 and come up !ith a short list of differentialdiagnoses.

>hat determines how the lesions appear

>hen cells are activated( it can be either!o lastic # osteoblasts form more bone )e* osteosarcoma+

o 5ytic # osteoclasts stimulated

Matri of tumor

END O0 TRANSCRIPTION

REETINS9

A!e:

Than- you for ta-ing pictures0 Trish('ello0 Bloc- F( 8ets eat more of these please )

Yan$an:

'ey Bloc- F( 'urrah for our very first &loc- &onding activity last +riday( HAlso0 lets all attend the T7 practices( T@Th at Calderon 'all andStudent 8ounge( Eamon mamooon( 8TS @I> IT T'IS A7((( J)D:

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RADIO 250 [8] LEC 09 Musculoskeletal Radiology