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Presentation1.pptx, radiological imaging of rediolucent lesions of bones.
This document provides information on radiolucent bone lesions, including giant cell tumor of bone (GCT), aneurysmal bone cyst (ABC), unicameral bone cyst (UBC), eosinophilic granuloma (EG), and non-ossifying fibroma (NOF). It describes the clinical features, locations, radiographic findings, and imaging appearances of each condition. Key radiographic findings include lytic and expansile lesions with thin or thick sclerotic rims and internal trabeculations. MRI is useful for evaluating soft tissue extension and detecting fluid-fluid levels in ABC.
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Introduction to radiological imaging of bone lesions, presented by Dr. Abd Allah Nazeer.
GCT is a benign tumor in skeletally mature patients (20-50 yrs). Clinical features include pain and swelling, with risks of pathologic fractures. Staging details outlined.
Radiographic characteristics of GCT including MRI findings, lytic lesions and T2 weighted images detailing bone destruction.
Various imaging studies of GCT including MRI of joint locations and additional findings through a bone scan.
ABC is a benign lesion with blood-filled cavities. Commonly found in patients under 20 and is associated with pain and fractures.
Radiological features of ABC including geographic lytic lesions and common locations. Imaging studies show fluid-fluid levels.
UBC is a fluid-filled lesion primarily affecting young patients. Imaging reveals geographic lesions with sclerosis.
EG predominantly affects children and appears as lytic lesions on various imaging modalities with non-mineralization.
MRI reveals the extent and characteristics of Eosinophilic Granuloma lesions with various appearances.
NOF is an intramedullary fibrous lesion common in teens. Imaging typically shows geographic, lytic characteristics.
Bone scan results for NOF and a closing slide thanking the audience.
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Presentation1.pptx, radiological imaging of rediolucent lesions of bones.
- 1. Radiological imaging ofradiolucent Lesions of Bone Dr/ ABD ALLAH NAZEER. MD.
- 2. (GCT, ABC, UBC,EG, NOF) Giant Cell Tumor of Bone (GCT) Osteoblastoma •Definition: Benign aggressive bone tumor composed primarily of “osteoclast-like” giant cells in a mostly vascular background of mononuclear to spindled stromal cells •The mononuclear cells coalesce to form the giant cells •Clinical features: •~5% of all biopsied primary bone tumors •Symptoms: pain and swelling often relieved by decreased activity •Pathologic fracture in 10-35% of patients Affects Skeletally Mature Patients (90%) •Age: 20-50 yrs old •Rare in children 1-2% •Approximately equal sex distribution
- 3. Location •Metaphysis and usuallygrow to the subchondral bone in the epiphysis •Distal Femur or Proximal Tibia—most common •Distal Radius (3rdMost Common Site: 10%) •Sacrum 7% •Humerus 6% •Pelvis 4% •Hands/Feet 5% •Multifocal 0.5-1% Staging: (Arabic Numerals) •Stage 1: Slowly Growing •Tumor is entirely intraosseous •Thin sclerotic rim around the tumor •Stage 2:Active •Tumor is entirely intraosseous but growing more rapidly •No sclerotic rim •Bone may be expanded or scalloped •Stage 3:Aggressive •Tumor has destroyed the cortex •Formed a soft tissue mass
- 4. Radiographic Findings: •Solitary eccentricgeographic lytic lesion arising from metaphysis and extending into epiphysis usually to the subchondral plate •Usually no margin or a faint margin of sclerosis surrounding the tumor •No matrix mineralization Expansile lesion •Lesions that extend through cortex are usually encased by a delicate shell of periosteal new bone often only detectable on a CT scan •Internal Trabeculations may be present •Reactive, Thickened Residual Trabeculae of Bone •Unusual periosteal reactions—rarely occur Bone scan –hot on bone scan •MRI > CT for evaluation of bone and soft tissue extent •T1: Intermediate Signal similar to muscle •T2: Heterogeneous: Low to intermediate signal intensity usually predominates mixed with high signal areas •Fluid-Fluid Levels: Secondary ABC changes •CT: •Absence of mineralization •Internal Trabeculations •Subtle periosteal reactions around soft tissue component
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- 7. Axial T1 ,T2 Weighted MRI: Stage 2 Giant Cell Tumor; No Extraosseous Extension.
- 8. X-Ray: Giant CellTumor of Distal Femur.
- 9. MRI of GiantCell Tumor of Distal Femur Demonstrating Cystic Changes and Confirms Geographic Pattern of Bone Destruction. Sharp Zone of Transition between Tumor and Normal Bone
- 10. MRI T2 Weightedof Giant Cell Tumor of Distal Femur.
- 11. X-Ray: Giant CellTumor of Proximal Tibia. Eccentric, Lytic Lesion •Metaphyseal with Extension into Epiphysis •Geographic Pattern •Minimal Surrounding Sclerosis •No Matrix Mineralization
- 12. Sharp Zone of Transitionbetween Tumor and Normal Bone (Geographic Lesion). CT Scan of Giant Cell Tumor of Proximal Tibia. Soft Tissue Component Surrounded by Egg Shell Rim of Calcification indicating Periosteum is Intact (Benign Lesion)
- 13. MRI T2 WeightedImage Demonstrating Multiple Fluid-Fluid Levels (Secondary ABC Changes). There are multiple fluid-fluid levels indicative of a secondary aneurysmal bone cyst component.
- 14. Giant Cell Tumorof Distal Radius (Stage 3) • Expansile Tumor Destroying Distal Radius. •Metaphyseal Origin with Destruction of Metaphysis and Epiphysis. •Multiple Internal Trabeculations.
- 15. Giant Cell Tumorof Proximal Fibula (Stage 3) • Large Expansile Lesion Destroyed Proximal Fibula •Internal Trabeculations •Sharp Zone of Transition between Tumor and Normal Fibula Internal Trabeculation Reactive Periosteum Intact
- 16. Giant Cell Tumorof the Sacrum.
- 17. Bone Scan DemonstratesIncreased Uptake in Area of Giant Cell Tumor of Distal Femur
- 18. Aneurysmal Bone Cyst(ABC) •Definition: Benign aggressive lesion of bone with cystic blood filled cavities. It is locally destructive. The cystic cavities are blood filled and the walls contain spindle cells, reactive osteoid and multinucleated giant cells. •50% arise secondary to a pre-existing lesion •Secondary ABC •Debate: Is ABC a cyst vs neoplasm vs a periosteal •Clinical features: •2% of all biopsied primary osseous neoplasms (1/2 as common as GCT of bone) •Usually<20 years of age (80%) •Pain, swelling, pathologic fracture (10-20%) •May be associated with trauma •Slightly more common in women
- 19. Aneurysmal Bone Cyst(ABC) •Location •Metaphysis Long Bone 70-80% •Distal Femur •Proximal Tibia •Spine: posterior elements –15% (thoracic, lumbar, cervical, sacral); In spine 50% may affect multiple spinous processes •Hands (10-15%) •Pelvis (5-10%) Radiology: •Eccentric, Parosteal or Central Geographic Lytic Lesion (Eccentric most common) •Metaphysis (80-90%), Diaphysis (10-20%) •Expansile Remodeling •Periosteal membrane usually intact CT/MRI •Bone scan –peripheral activity (65%) •Fluid-fluid levels (CT/MRI) –nonspecific representing sedimentation of blood
- 20. ABC Distal FemurEccentric, Geographic, Metaphyseal •Eccentric, •Geographic, •Metaphyseal, •Well Circumscribed, •Sclerotic Margin, •Skeletally Immature Reactive Periosteal New Bone
- 21. MRI T2 WeightedFluid-Fluid Level.
- 22. Fluid-Fluid Levels ABC ProximalTibia Eccentric Expansion of Bone.
- 23. Two cases ofABC Proximal Radius.
- 24. Aneurysmal bone cystwith air fluid level.
- 25. ABC: MRI Fluid-FluidLevels
- 26. ABC of LeftIschium Expansile Radiolucent, Skeletally Immature, Internal Trabeculations Fluid-Fluid Levels
- 27. ABC of Medial Endof Clavicle
- 28. Unicameral Bone Cyst(UBC)Simple Bone Cyst •Definition: A fluid containing lesion lined by thin fibro-connective tissue membrane usually arising central in metaphysis of long bone adjacent to physis •3% of all biopsied primary osseous neoplasms •Young patients < 20 yr. old (85%) •Male>Female, 3:1 •Pathologic fracture 50% •Etiology: Lymphatic/Venous Obstruction vs Synovial Origin Location: •Proximal Humerus •Proximal Femur •Proximal Tibia •Pelvis, Calcaneous—More common over 20 years of age •Clinical: •Incidental finding •Mild pain, swelling, stiffness in adjacent joint •Sudden pain secondary to pathological fracture
- 29. Radiology: •Geographic lesion –centralmetaphyseal (active) adjacent to physis •Thin rim of surrounding sclerosis •Can be diaphyseal (latent); lesion migrates distally with growth •Mild expansile remodeling (typically, not as expansile as an ABC) Overlying cortex is thin but never penetrated •May be multilocular/trabeculated due to osseous ridges on the inner wall of the cyst •Pathologic fracture –“fallen fragment” sign •May contain calcified granules/reactive osteoid/new bone formation •CT/MR-simple fluid in non complicated case •CT/MR-complicated case •Soft tissue with unusual thick membrane •Fluid-fluid/gas-fluid levels: possible with Pathological Fracture
- 30. UBC of ProximalFemur. Central lesion, •Geographic, •Thin rim of sclerosis, •Mildly expansile, •No mineralization.
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- 34. Eosinophilic Granuloma •Sites: •Flat Bones(most common—70%) •Skull, Mandible, Ribs •Pelvis •Femur •Humerus •Tibia •Hands and Feet are rare in solitary disease Age:5-15 years (85% of patients less than 30 years; 60 % less than age 10) •95% are Caucasian •Pain, tenderness and fever •Mild peripheral eosinophilia in 5-10% of patients
- 35. Radiology: •Variable radiological appearance(Benign to Malignant) •Geographic or Permeative •Onion Skin/Lamellated Periosteal Reaction •Any bone and any portion of the bone (epiphyseal, metaphyseal, diaphyseal) •Lytic, Radiolucent Lesion, No Mineralization •May have rind of sclerosis •5-10% of patients have an associated soft tissue mass •Sequastrum (button-like); Hole in a Hole appearance Skull: Beveled Edge; Button Sequastrum •Flat Bone: Hole in a Hole •Spine: Vertebra Plana
- 36. X-Ray: EG ofSkull
- 37. X-Ray and MRI:EG of Spine (Vertebra Plana)
- 38. EG of ScapulaSpine.
- 39. EG of LeftAcetabulum.
- 40. X ray ofFemur: EG
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- 42. Nonossifying Fibroma (NOF). •Definition:Intracortical proliferation of fibrous tissue and histiocytes that extends into the intramedullary canal •Fibrous Cortical Defect: Small lesion (up to 1cm) that involve only the cortex •Jaffe-Campanacci Syndrome: Multiple NOFs with café au lait spots •Usually found incidentally on a radiograph •Large lesions may cause pain from pathological fracture or stress injury from weakened bone (microscopic fractures) Many believe that NOFs start as fibrous cortical defects that enlarge •Can be a precursor to an ABC •NOFs: Teenage years <25 years; Usually heal spontaneously in a patient’s 20s •Males>Females 2:1 •Sites: Distal Tibia, Distal Femur, Proximal Tibia, Fibula (90% of lesions).
- 43. Radiology: Nonossifying Fibroma(NOF) •Lytic, Geographic, Radiolucent Lesion •Metadiaphyseal •Sharply circumscribed with thick rind of sclerosis •Internal Trabeculations •Intracortical with growth into the intramedullary canal •May expand slightly into soft tissue •Heal from diaphysis to epiphysis (fill in with bone) •Multiple NOFs usually more expansile and larger than solitary NOFs.
- 44. Geographic, Eccentric Metadiaphyseal Thick ScleroticRim Well Circumscribed Internal Trabeculations X-ray Tibia: NOF with Pathological Fracture
- 45. MRI Tibia :NOF with Pathological Fracture
- 46. X ray Femur:NOF Geographic •Metadiaphyseal •Eccentric •Thick Sclerotic rim •Internal Trabeculations •No Mineralization •May be expansile especially in multiple NOFs
- 47. X ray Tibia/Fibula:Multiple NOFs Geographic Lesion •Eccentric •Metadiaphyseal •Well Circumscribed •Sclerotic rim
- 49. Bone Scan: NOFRight Distal Radius Mild Uptake.
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