Department of Radiology BONE IMAGING Presented by Dr Dalia Al –Falaki Department of Radiology Colleage of medicine

BONE TUMORS a-primary:benign, malignant. b- secondary

Differance between benign & malignant tumor 1-soft tissue swelling +ve in malignant tumor due to soft tissue infilteration. -ve in benign tumor. 2- periosteal reaction: +ve n malignant tumor. Periosteal reaction can be linear,layering, triangular. 3- zone of transition from normal to abnormal area: Wide in malignant tumor. Narrow in benign lesion. 4-malignant tumor cause bone destruction. Benign tumor cause bone expansion.

Benign tumor Osteoma Bone mass, can affect flat bone, sinuses, usually in frontal sinus , in form of well circumscribed dense white mass called ivory osteoma.

Frontal view of skull Osteoma

Lateral view of skull Osteoma

Frontal sinus giant osteoma

Osteoid osteoma: Radiological feature: focal area of increase bone density, located usually in the shaft of long bone, in particular tibia , with presence of central osteolytic area inside it ( nidus ), this lesion cause pain in bone at night , relieved by aspirin, differential diagnosis is osteomylitis of Garee.

Tibia osteoid osteoma

Osteoid osteoma

X-ray of pelvis Focal area of marked cortical thickenning involve medial aspect of left femoral shaft contain lucent area which represent the nidus

Enchondroma: Benign tumor of cartilage , focal osteolytic lesion, with sclerotic margin, cause some expansion of bone, may contain central calcification, seen in the phalynges.

Simple bone cyst: Focal osteolytic lesion, with sclerotic margin , with some expansion of bone, seen in immature skeleton, , seen in proximal shaft of humerus, can be associated with pathological fracture.

Simple bone cyst

Simple bone cyst in distal radius

Exostosis Can be single or multiple (ollier disease ), bony projection arise from cortex , directed away from near by joint, Some times its surface covered by cartilaginous cap, carilage capped exostosis may change into malignant chondrosarcoma.

HAEMMAGIOMA OF THE SPINE: Could affect single or multiple vertebra, seen as reduction in density of the vertebra with prominent vertical striation.

MALIGNANT BONE TUMOR Osteosarcoma Commonest malignant bone tumor, affect young adolescent, presented as local pain and swelling, usually around the knee joint. Radiological feature: 1-bony lesion: metaphyseal location , either bone destruction(osteolytic ) , or bone bone formation ( osteoblstic ) or mixed. 2- periosteal reaction usually triangular type called cod-mann triangle. 3- soft tissue swelling, which displace adjacent fat plane.

Ewing sarcoma: 1- start in medullary area of long bone diaphysis. 2-bony lesion is destructive, osteolytic. 3- periosteal reaction is fusiform, onion peel type( layering type ).

Osteoclastoma ( giant cell tumor) It is classified as benign tumor but is locally aggressive tumor, occur in mature skeleton, affect subarticular end of long bone around knee joint, purely osteolytic lesion, eccentric location , some bone expansion, with unresorbed trabeculae give appearance of bone septa inside the osteolytic lesion, called soap bubble appearance.

Secondary malignant bone tumor ( metastasis ): Metastatic deposit are more common than primary tumor, present as pain, pathological fracture & swelling. The more malignant primary tumor , the more rapid bone metastatic disease. Some primary tumor present as bone metastasis years before we discover the primary one. Skull, pelvic bone ,spine , ribs , proximal humora and femora are site of bone metastatic disease.

Types of metastatic bone disease : 1-majoritry are osteolytic e.g from breast cancer. 2-less are osteoblastic e.g. from G.I.T.. 3- can be mixed e.g. from prostatic tumor.