bone tumor radiological approach
TRANSCRIPT
![Page 1: Bone tumor radiological approach](https://reader033.vdocuments.us/reader033/viewer/2022061606/554b30c7b4c905a2058b4f41/html5/thumbnails/1.jpg)
RADIOLOGIAL APPROACH TO BONE TUMORS
DR. C. K.VASU, M.D
![Page 2: Bone tumor radiological approach](https://reader033.vdocuments.us/reader033/viewer/2022061606/554b30c7b4c905a2058b4f41/html5/thumbnails/2.jpg)
THERAPEUTIC GOALS
DO NOT OVERTREAT A BENIGN TUMOR
DO NOT UNDERTREAT A MALIGNANT TUMOR
DO NOT MISDIRECT BIOPSY
![Page 3: Bone tumor radiological approach](https://reader033.vdocuments.us/reader033/viewer/2022061606/554b30c7b4c905a2058b4f41/html5/thumbnails/3.jpg)
RADIOLOGIST CAN SEE THE THREE DIMENSIONAL GROSS PATHOLOGY
IF RADIOLOGIC FINDINGS ARE NOT CORRELATING WITH THE PATHOLOGY FINDINGS:SPECIAL STAINS, ADDITIONAL IMAGES WILL HELP
TUMOR MAY HAVE VARYING HISTOLOGY AND REPRESENTATIVE SAMPLE FROM EPICENTRE OF THE LESION HAS TO BE TAKEN
![Page 4: Bone tumor radiological approach](https://reader033.vdocuments.us/reader033/viewer/2022061606/554b30c7b4c905a2058b4f41/html5/thumbnails/4.jpg)
ROLE OF PLAIN RADIOGRAPH
INITIAL EXAMINATION –STARTS THE DIAGNOSTIC ALGORITHM
SCREENING, DETECTION,DIAGNOSIS,FOLLOWUP
IN THIS COST-CONSCIOUS ERA
![Page 5: Bone tumor radiological approach](https://reader033.vdocuments.us/reader033/viewer/2022061606/554b30c7b4c905a2058b4f41/html5/thumbnails/5.jpg)
SYSTEMATIC APPROACH
AGE
SITE
ZONE OF TRANSITION
MATRIX
CORTEX
PERIOSTEAL REACTION
SOFT TISSUE COMPONENT
SINGLE - MULTIPLE
![Page 6: Bone tumor radiological approach](https://reader033.vdocuments.us/reader033/viewer/2022061606/554b30c7b4c905a2058b4f41/html5/thumbnails/6.jpg)
AGE AT PRESENTATION
DIFFERENTIAL DIAGNOSIS CAN BE NARROWED
1 ST DECADE : NEUROBLASTOMA,LEUKEMIA2 ND DECADE : OSTEOSARCOMA, EWINGS SARCOMA3RD DECADE: GIANT CELL TUMORELDERLY : METASTASIS, CHONDROSARCOMA
CLUE TO AGE : FROM EPIPHYSEAL FUSION
![Page 7: Bone tumor radiological approach](https://reader033.vdocuments.us/reader033/viewer/2022061606/554b30c7b4c905a2058b4f41/html5/thumbnails/7.jpg)
OSTEOSARCOMA@
![Page 8: Bone tumor radiological approach](https://reader033.vdocuments.us/reader033/viewer/2022061606/554b30c7b4c905a2058b4f41/html5/thumbnails/8.jpg)
CHONDRO BLASTOMA
![Page 9: Bone tumor radiological approach](https://reader033.vdocuments.us/reader033/viewer/2022061606/554b30c7b4c905a2058b4f41/html5/thumbnails/9.jpg)
GCT@
![Page 10: Bone tumor radiological approach](https://reader033.vdocuments.us/reader033/viewer/2022061606/554b30c7b4c905a2058b4f41/html5/thumbnails/10.jpg)
LOCATION
EPIPHYSEAL :
CHONDROBLASTOMA, GIANT CELL TUMOUR
METAPHYSEAL :
OSTEOSARCOMA, ANEURYSMAL BONE CYST
DIAPHYSEAL :
EWINGS SARCOMA
![Page 11: Bone tumor radiological approach](https://reader033.vdocuments.us/reader033/viewer/2022061606/554b30c7b4c905a2058b4f41/html5/thumbnails/11.jpg)
CHONDRO BLASTOMA@
![Page 12: Bone tumor radiological approach](https://reader033.vdocuments.us/reader033/viewer/2022061606/554b30c7b4c905a2058b4f41/html5/thumbnails/12.jpg)
GCT / ABC
![Page 13: Bone tumor radiological approach](https://reader033.vdocuments.us/reader033/viewer/2022061606/554b30c7b4c905a2058b4f41/html5/thumbnails/13.jpg)
EWINGS SARCOMA
![Page 14: Bone tumor radiological approach](https://reader033.vdocuments.us/reader033/viewer/2022061606/554b30c7b4c905a2058b4f41/html5/thumbnails/14.jpg)
EWINGS SARCOMA
![Page 15: Bone tumor radiological approach](https://reader033.vdocuments.us/reader033/viewer/2022061606/554b30c7b4c905a2058b4f41/html5/thumbnails/15.jpg)
ZONE OF TRANSITION IT IS AN ASSESSMENT OF THE
BIOLOGICAL ACTIVITY GEOGRAPHIC OR TYPE 1 (LODWIG) 1A----WITH SCLEROSIS: BONE DEPOSITION
TO REDIRECT TRANSMITTED FORCES IN TYPE 1A LESIONS IDEAL POSTOP
RADIOGRAPH SHOULD SHOW COMPLETE REMOVAL OF NOT ONLY SCLEROTIC RIM BUT ALSO SEVERAL MMS “NORMAL BONE”
![Page 16: Bone tumor radiological approach](https://reader033.vdocuments.us/reader033/viewer/2022061606/554b30c7b4c905a2058b4f41/html5/thumbnails/16.jpg)
IF SCLEROTIC RIM REMAINS HIGHER RECURRENCE CHANCE
EX: CHONDROBLASTOMA, BONE CYST
TYPE 1B:
BIOLOGIC ACTIVITY IS SLIGHTLY MORE: NO SCLEROTIC RIM
EX: GIANT CELL TUMOR
![Page 17: Bone tumor radiological approach](https://reader033.vdocuments.us/reader033/viewer/2022061606/554b30c7b4c905a2058b4f41/html5/thumbnails/17.jpg)
TYPE 1C LESION
LYTIC LESION WITH ILL DEFINED MARGIN: THEY ARE MALIGNANT UNLESS PROVED OTHERWISE:
EX: CHONDROSARCOMA,
FIBROSARCOMA
![Page 18: Bone tumor radiological approach](https://reader033.vdocuments.us/reader033/viewer/2022061606/554b30c7b4c905a2058b4f41/html5/thumbnails/18.jpg)
MULTIPLE CLUSTERED SMALL HOLES(<5MM)
(TYPE 3) PERMEATIVE PATTERN
LUCENT LINEAR STREAKS DD IS SIMILAR: OSTEOSARCOMA,
EWINGS SARCOMA
(TYPE 2)MOTH EATEN
![Page 19: Bone tumor radiological approach](https://reader033.vdocuments.us/reader033/viewer/2022061606/554b30c7b4c905a2058b4f41/html5/thumbnails/19.jpg)
LYTIC LESION WITH SCLEROTIC RING
![Page 20: Bone tumor radiological approach](https://reader033.vdocuments.us/reader033/viewer/2022061606/554b30c7b4c905a2058b4f41/html5/thumbnails/20.jpg)
GCT
![Page 21: Bone tumor radiological approach](https://reader033.vdocuments.us/reader033/viewer/2022061606/554b30c7b4c905a2058b4f41/html5/thumbnails/21.jpg)
CHONDROSARCOMA RADIUS
![Page 22: Bone tumor radiological approach](https://reader033.vdocuments.us/reader033/viewer/2022061606/554b30c7b4c905a2058b4f41/html5/thumbnails/22.jpg)
OSTEOGENIC SARCOMA
![Page 23: Bone tumor radiological approach](https://reader033.vdocuments.us/reader033/viewer/2022061606/554b30c7b4c905a2058b4f41/html5/thumbnails/23.jpg)
PERMEATIVE PATTERN
![Page 24: Bone tumor radiological approach](https://reader033.vdocuments.us/reader033/viewer/2022061606/554b30c7b4c905a2058b4f41/html5/thumbnails/24.jpg)
CORTICAL BREAK
MALIGNANT LESIONS
:OSTEOSARCOMA,EWINGS SARCOMA
BENIGN LESIONS: NO CORTICAL BREAK USUALLY:
EX: GCT,ABC
![Page 25: Bone tumor radiological approach](https://reader033.vdocuments.us/reader033/viewer/2022061606/554b30c7b4c905a2058b4f41/html5/thumbnails/25.jpg)
GIANT CELL TUMOUR PATELLA
![Page 26: Bone tumor radiological approach](https://reader033.vdocuments.us/reader033/viewer/2022061606/554b30c7b4c905a2058b4f41/html5/thumbnails/26.jpg)
DESMOPLAS-TIC FIBROMA
![Page 27: Bone tumor radiological approach](https://reader033.vdocuments.us/reader033/viewer/2022061606/554b30c7b4c905a2058b4f41/html5/thumbnails/27.jpg)
OSTEOCHONDROMA@
![Page 28: Bone tumor radiological approach](https://reader033.vdocuments.us/reader033/viewer/2022061606/554b30c7b4c905a2058b4f41/html5/thumbnails/28.jpg)
OSTEOCHONDROMA
![Page 29: Bone tumor radiological approach](https://reader033.vdocuments.us/reader033/viewer/2022061606/554b30c7b4c905a2058b4f41/html5/thumbnails/29.jpg)
PERIOSTEAL REACTION
OUTER FIBROUS LAYER AND INNER CELLULAR LAYER.
10-21DAYS : SEEN EARLIER IN YOUNGER PATIENTS
INDICATION OF BIOLOGICAL ACTIVITY
![Page 30: Bone tumor radiological approach](https://reader033.vdocuments.us/reader033/viewer/2022061606/554b30c7b4c905a2058b4f41/html5/thumbnails/30.jpg)
TYPES OF PERIOSTEAL REACTION
CONTINUOUS: LAMELLATED (ONION –PEEL)
DISCONTINUOUS : CODMAN ANGLES COMPLEX: LAMELLATED + CODMAN MORE EXTENSIVE AND COMPLEX
THE PERIOSTEAL REACTION GREATER BIOLOGICAL ACTIVITY
![Page 31: Bone tumor radiological approach](https://reader033.vdocuments.us/reader033/viewer/2022061606/554b30c7b4c905a2058b4f41/html5/thumbnails/31.jpg)
EWINGS SARCOMA@
![Page 32: Bone tumor radiological approach](https://reader033.vdocuments.us/reader033/viewer/2022061606/554b30c7b4c905a2058b4f41/html5/thumbnails/32.jpg)
LAMELLAR APPEARENCE
![Page 33: Bone tumor radiological approach](https://reader033.vdocuments.us/reader033/viewer/2022061606/554b30c7b4c905a2058b4f41/html5/thumbnails/33.jpg)
SUN RAY
![Page 34: Bone tumor radiological approach](https://reader033.vdocuments.us/reader033/viewer/2022061606/554b30c7b4c905a2058b4f41/html5/thumbnails/34.jpg)
OSTEOSARCOMA
![Page 35: Bone tumor radiological approach](https://reader033.vdocuments.us/reader033/viewer/2022061606/554b30c7b4c905a2058b4f41/html5/thumbnails/35.jpg)
PAROSTEAL OSTEOSARCOMA
![Page 36: Bone tumor radiological approach](https://reader033.vdocuments.us/reader033/viewer/2022061606/554b30c7b4c905a2058b4f41/html5/thumbnails/36.jpg)
EWINS SARCOMA
![Page 37: Bone tumor radiological approach](https://reader033.vdocuments.us/reader033/viewer/2022061606/554b30c7b4c905a2058b4f41/html5/thumbnails/37.jpg)
MATRIX OSSEUS MATRIX: OSTEOMA,OSTEOID
OSTEOMA---CLOUD LIKE RELATIVELY HOMOGENOUS AREA OF BLASTIC CHANGE
CARTILAGE MATRIX: STIPLLED, CURVILINEAR CALCIFICATION(RINGS AND ARCS)---ENCHONDROMA,CHONDROSARCOMA
NON-MINERALIZED MATRIX: GIANT CELL TUMOR, OSTEOLYTIC OSTEOSARCOMA
![Page 38: Bone tumor radiological approach](https://reader033.vdocuments.us/reader033/viewer/2022061606/554b30c7b4c905a2058b4f41/html5/thumbnails/38.jpg)
OSTEOID OSTEOMA
D/D:GARRE’S OSTEOMYELITIS
![Page 39: Bone tumor radiological approach](https://reader033.vdocuments.us/reader033/viewer/2022061606/554b30c7b4c905a2058b4f41/html5/thumbnails/39.jpg)
OSTEOSARCOMA@
![Page 40: Bone tumor radiological approach](https://reader033.vdocuments.us/reader033/viewer/2022061606/554b30c7b4c905a2058b4f41/html5/thumbnails/40.jpg)
CHONDRO SARCOMA@
![Page 41: Bone tumor radiological approach](https://reader033.vdocuments.us/reader033/viewer/2022061606/554b30c7b4c905a2058b4f41/html5/thumbnails/41.jpg)
MEDULLARY NECROSIS
![Page 42: Bone tumor radiological approach](https://reader033.vdocuments.us/reader033/viewer/2022061606/554b30c7b4c905a2058b4f41/html5/thumbnails/42.jpg)
NO MATRIX--FIBROSARCOMA
![Page 43: Bone tumor radiological approach](https://reader033.vdocuments.us/reader033/viewer/2022061606/554b30c7b4c905a2058b4f41/html5/thumbnails/43.jpg)
SOFT TISSUE COMPONENT
DETECTED ON PLAIN XRAY-DISPLACED FAT PLANE
ROLE OF CT AND MRI
![Page 44: Bone tumor radiological approach](https://reader033.vdocuments.us/reader033/viewer/2022061606/554b30c7b4c905a2058b4f41/html5/thumbnails/44.jpg)
FIBROSARCOMA@
![Page 45: Bone tumor radiological approach](https://reader033.vdocuments.us/reader033/viewer/2022061606/554b30c7b4c905a2058b4f41/html5/thumbnails/45.jpg)
EWINGS SARCOMA
![Page 46: Bone tumor radiological approach](https://reader033.vdocuments.us/reader033/viewer/2022061606/554b30c7b4c905a2058b4f41/html5/thumbnails/46.jpg)
LESION MULTIPLICITY
KEY DIAGNOSTIC SIGN
PRIMARY BONE TUMORS USUALLY SINGLE
PRIMARY : SECONDARY --1: 500
![Page 47: Bone tumor radiological approach](https://reader033.vdocuments.us/reader033/viewer/2022061606/554b30c7b4c905a2058b4f41/html5/thumbnails/47.jpg)
MULTIPLE EXOSTOSIS
![Page 48: Bone tumor radiological approach](https://reader033.vdocuments.us/reader033/viewer/2022061606/554b30c7b4c905a2058b4f41/html5/thumbnails/48.jpg)
OLLIERS DISEASE
![Page 49: Bone tumor radiological approach](https://reader033.vdocuments.us/reader033/viewer/2022061606/554b30c7b4c905a2058b4f41/html5/thumbnails/49.jpg)
METASTASIS-from bronchus@
![Page 50: Bone tumor radiological approach](https://reader033.vdocuments.us/reader033/viewer/2022061606/554b30c7b4c905a2058b4f41/html5/thumbnails/50.jpg)
QUIZ
![Page 51: Bone tumor radiological approach](https://reader033.vdocuments.us/reader033/viewer/2022061606/554b30c7b4c905a2058b4f41/html5/thumbnails/51.jpg)
OSTEOCHONDROMA
![Page 52: Bone tumor radiological approach](https://reader033.vdocuments.us/reader033/viewer/2022061606/554b30c7b4c905a2058b4f41/html5/thumbnails/52.jpg)
OSTEOCHONDROMA
METAPHYSEAL
GROWS AWAY FROM THE JOINT
ANY AGE
NO CORTICAL BREAK
NORMAL CORTEX WITH WHICH IT IS CONTINUOUS
![Page 53: Bone tumor radiological approach](https://reader033.vdocuments.us/reader033/viewer/2022061606/554b30c7b4c905a2058b4f41/html5/thumbnails/53.jpg)
CHONDRO BLASTOMA@
![Page 54: Bone tumor radiological approach](https://reader033.vdocuments.us/reader033/viewer/2022061606/554b30c7b4c905a2058b4f41/html5/thumbnails/54.jpg)
CHONDROBLASTOMACARTILAGINOUS
MATRIXBEFORE EPIPHYSEAL
FUSIONNARROW ZONE OF
TRANSITIONEPIPHYSEAL
![Page 55: Bone tumor radiological approach](https://reader033.vdocuments.us/reader033/viewer/2022061606/554b30c7b4c905a2058b4f41/html5/thumbnails/55.jpg)
GCT
![Page 56: Bone tumor radiological approach](https://reader033.vdocuments.us/reader033/viewer/2022061606/554b30c7b4c905a2058b4f41/html5/thumbnails/56.jpg)
GIANT CELL TUMOUR
EPIPHYSEAL20-45 YEARSMATRIX NOT
MINERALIZEDNARROW ZONE OF
TRANSITION
![Page 57: Bone tumor radiological approach](https://reader033.vdocuments.us/reader033/viewer/2022061606/554b30c7b4c905a2058b4f41/html5/thumbnails/57.jpg)
OSTEOSARCOMA
![Page 58: Bone tumor radiological approach](https://reader033.vdocuments.us/reader033/viewer/2022061606/554b30c7b4c905a2058b4f41/html5/thumbnails/58.jpg)
OSTEOSARCOMA
15-25 YEARS2 ND PEAK AT 40+METAPHYSEALOSTEOID MATRIXCODMAN,SUNBURSTZONE OF TRANSITION
![Page 59: Bone tumor radiological approach](https://reader033.vdocuments.us/reader033/viewer/2022061606/554b30c7b4c905a2058b4f41/html5/thumbnails/59.jpg)
CHONDROSARCOMA
![Page 60: Bone tumor radiological approach](https://reader033.vdocuments.us/reader033/viewer/2022061606/554b30c7b4c905a2058b4f41/html5/thumbnails/60.jpg)
CHONDROSARCOMA 40 + AGE GROUP
MATRIX CALCIFIED
DISPROPORTIONATE SOFT TISSUE
ENDOSTEAL SCALLOPING
![Page 61: Bone tumor radiological approach](https://reader033.vdocuments.us/reader033/viewer/2022061606/554b30c7b4c905a2058b4f41/html5/thumbnails/61.jpg)
![Page 62: Bone tumor radiological approach](https://reader033.vdocuments.us/reader033/viewer/2022061606/554b30c7b4c905a2058b4f41/html5/thumbnails/62.jpg)
EWINGS SARCOMA AGE GROUP—5-30 YEARS ONION PEEL PERIOSTEAL
REACTION DD OSTEOMYELITIS WIDE ZONE OF TRANSITION DIAPHYSEAL
![Page 63: Bone tumor radiological approach](https://reader033.vdocuments.us/reader033/viewer/2022061606/554b30c7b4c905a2058b4f41/html5/thumbnails/63.jpg)
NO MATRIX--FIBROSARCOMA
![Page 64: Bone tumor radiological approach](https://reader033.vdocuments.us/reader033/viewer/2022061606/554b30c7b4c905a2058b4f41/html5/thumbnails/64.jpg)
FIBROSARCOMA
NO MINERALIZED MATRIX
LARGE SOFT TISSUE
DIAPHYSEAL
CORTICAL BREAK
![Page 65: Bone tumor radiological approach](https://reader033.vdocuments.us/reader033/viewer/2022061606/554b30c7b4c905a2058b4f41/html5/thumbnails/65.jpg)
OSTEOID OSTEOMA
![Page 66: Bone tumor radiological approach](https://reader033.vdocuments.us/reader033/viewer/2022061606/554b30c7b4c905a2058b4f41/html5/thumbnails/66.jpg)
OSTEOID OSTEOMA
SCLEROTIC
NIDUS
WELL DEFINED
NO CORTICAL BREAK
![Page 67: Bone tumor radiological approach](https://reader033.vdocuments.us/reader033/viewer/2022061606/554b30c7b4c905a2058b4f41/html5/thumbnails/67.jpg)
![Page 68: Bone tumor radiological approach](https://reader033.vdocuments.us/reader033/viewer/2022061606/554b30c7b4c905a2058b4f41/html5/thumbnails/68.jpg)
HEMANGIOMA SPINE
![Page 69: Bone tumor radiological approach](https://reader033.vdocuments.us/reader033/viewer/2022061606/554b30c7b4c905a2058b4f41/html5/thumbnails/69.jpg)
![Page 70: Bone tumor radiological approach](https://reader033.vdocuments.us/reader033/viewer/2022061606/554b30c7b4c905a2058b4f41/html5/thumbnails/70.jpg)
EWING’S SARCOMA
![Page 71: Bone tumor radiological approach](https://reader033.vdocuments.us/reader033/viewer/2022061606/554b30c7b4c905a2058b4f41/html5/thumbnails/71.jpg)
![Page 72: Bone tumor radiological approach](https://reader033.vdocuments.us/reader033/viewer/2022061606/554b30c7b4c905a2058b4f41/html5/thumbnails/72.jpg)
HEMANGIOMA
![Page 73: Bone tumor radiological approach](https://reader033.vdocuments.us/reader033/viewer/2022061606/554b30c7b4c905a2058b4f41/html5/thumbnails/73.jpg)
![Page 74: Bone tumor radiological approach](https://reader033.vdocuments.us/reader033/viewer/2022061606/554b30c7b4c905a2058b4f41/html5/thumbnails/74.jpg)
IVORY VERTEBRA
![Page 75: Bone tumor radiological approach](https://reader033.vdocuments.us/reader033/viewer/2022061606/554b30c7b4c905a2058b4f41/html5/thumbnails/75.jpg)
OSTEOCHONDROMA
![Page 76: Bone tumor radiological approach](https://reader033.vdocuments.us/reader033/viewer/2022061606/554b30c7b4c905a2058b4f41/html5/thumbnails/76.jpg)
OSTEOCHONDROMA
![Page 77: Bone tumor radiological approach](https://reader033.vdocuments.us/reader033/viewer/2022061606/554b30c7b4c905a2058b4f41/html5/thumbnails/77.jpg)
![Page 78: Bone tumor radiological approach](https://reader033.vdocuments.us/reader033/viewer/2022061606/554b30c7b4c905a2058b4f41/html5/thumbnails/78.jpg)
![Page 79: Bone tumor radiological approach](https://reader033.vdocuments.us/reader033/viewer/2022061606/554b30c7b4c905a2058b4f41/html5/thumbnails/79.jpg)