Bone or cartilage mass imaging

Bone or Cartilage Mass Microchapters
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Maria Fernanda Villarreal, M.D. [2]

Imaging

Plain Radiograph

Periosteal reaction

• Also known as " periostitis/periosteitis", is a non specific radiographic finding that occurs with periosteal irritation.
• Periosteal reactions may be broadly characterized by pattern and tumor nature (benign/malignant)
• Periosteal reaction is a radiographic feature that helps to characterize a bone lesion
• Common periosteal reactions, include:

• Single layer
• Multilayered (onion-skin)
• Solid
• Spiculated
• Perpendicular (hair-on-end)
• Divergent (sunburst)
• Sloping (velvet)
• Disorganised/complex
• Codman triangle

Location

Margin

Opacity

Mineralization

Size

Cortical involvement

Soft-tissue component

Gallery

Plain Radiograph

• 
  Osteosarcoma with Codman triangles: the tumor is essentially lytic and destructive with irregular, permeative margins, and soft tissue extension. Codman triangles (reactive periosteal new bone formation around the edges) are very prominent
  Adapted from Creative Commons 3.0
• 
  Giant cell tumor: located on distal radius
  Adapted from Radiopedia
• 
  Pathological fracture: located in the metaphyseal region
  Adapted from Radiopedia
• 
  Rind sign: a lesion surrounded by a layer of thick, sclerotic reactive bone (rind) and is suggestive of fibrous dysplasia
  Adapted from Radiopedia
• 
  Sunburst appearance: a type of periosteal reaction giving the appearance of a sunburst secondary to an aggressive periostitis. Present in aggresive tumors, such as: osteosarcoma, Ewing sarcoma, and osteoblastic metastases (e.g. prostate, lung or breast cancer)
  Adapted from Radiopedia
• 
  Onion skin sign : Also known as "multilayered periosteal reaction" demonstrates multiple concentric parallel layers of new bone adjacent to the cortex, reminiscent of the layers on an onion. Associated with osteosarcoma,Ewing sarcoma, and acute osteomyelitis (*) Parallel layers of new bone
  Adapted from Radiopedia
• 
  Cockade sign: Classic appearance of an intraosseous lipoma of the calcaneus which presents as a well-defined lytic lesion with a central calcification resembling a cockade
  Adapted from Radiopedia
• 
  Geographic skull sign: radiographic appearance which is seen at eosinophilic granuloma. Destructive lytic bone lesion, edges of which may be bevelled, scalloped or confluent
  Adapted from Radiopedia

CT

• 
  String sign : appearance a radiolucent cleavage plane between portions of the tumor and cortex of the affected bone
  Adapted from Radiopedia
• 
  Osteoblastoma: Internal matrix mineralisation is better appreciated on CT
  Adapted from Radiopedia

MRI

• 
  MRI- Onion skin sign
  Adapted from Radiopedia
• 
  MRI-Enchondroma : Well circumscribed somewhat lobulated masses replacing marrow
  Adapted from Radiopedia

References

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