Aggressive bone disease

Aggressive bone disease

The radiograph is the first imaging technique for destructive lesions in bones. There is considerable experience required in the interpretation of these films, especially with regard to whether the lesion is benign or malignant ( Figure 8.24 calcification in tumours of muscle, tendon and subcutane - ous fat. When a lesion is detected, there needs to be an early decision as to whether this is benign or malignant. If there is a suspicion of malignancy on the radiograph, or any uncer - tainty , then local staging is indicated. This is best performed by MRI for both bone and soft-tissue lesions ( Figure 8.25 ) . At this stage, it is likely that a biopsy will be indicated, and preferably under image guidance. Soft-tissue and bone biopsy needles may be guided by CT , ultrasound or interventional MRI systems. The route of puncture should avoid vital struc - tures and must be agreed with the surgeon, who will perform local excision if the lesion proves to be malignant. Care should be taken to avoid contaminating other compartments. In all circumstances, samples are best sent for both histopathological and microbiological examination. It may be di ffi cult to tell on imaging whether or not a lesion is infected, and histology often provides a clear diagnosis in inflammatory conditions. Bone scintigraphy is useful in detecting whether a lesion is solitary or multiple, although whole-body MRI is becoming available. Summary box 8.11 Imaging of aggressive lesions in bone /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF

(a) Figure 8.24 A n t e r o p o s t e r i o r (a) a n d l a t e r a l (b) r a d i o

graphs of the left knee in a young patient with knee pain. There is a mixed lucent and sclerotic lesion of the distal femur with breach of the cortex medially and soft-tissue extension seen anteriorly and posteriorly (arrows). The location and appearances are consistent with osteosar

coma. Plain radiographs are important as a /f_i rst investigation MRI is best for local staging Bone scintigraphy or whole-body MRI for solitary or multiple lesion determination CT detects lung metastases Fluoroscopy, CT, MRI or ultrasound can be used to guide the biopsy

Aggressive bone disease

The radiograph is the first imaging technique for destructive lesions in bones. There is considerable experience required in the interpretation of these films, especially with regard to whether the lesion is benign or malignant ( Figure 8.24 calcification in tumours of muscle, tendon and subcutane - ous fat. When a lesion is detected, there needs to be an early decision as to whether this is benign or malignant. If there is a suspicion of malignancy on the radiograph, or any uncer - tainty , then local staging is indicated. This is best performed by MRI for both bone and soft-tissue lesions ( Figure 8.25 ) . At this stage, it is likely that a biopsy will be indicated, and preferably under image guidance. Soft-tissue and bone biopsy needles may be guided by CT , ultrasound or interventional MRI systems. The route of puncture should avoid vital struc - tures and must be agreed with the surgeon, who will perform local excision if the lesion proves to be malignant. Care should be taken to avoid contaminating other compartments. In all circumstances, samples are best sent for both histopathological and microbiological examination. It may be di ffi cult to tell on imaging whether or not a lesion is infected, and histology often provides a clear diagnosis in inflammatory conditions. Bone scintigraphy is useful in detecting whether a lesion is solitary or multiple, although whole-body MRI is becoming available. Summary box 8.11 Imaging of aggressive lesions in bone /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF

(a) Figure 8.24 A n t e r o p o s t e r i o r (a) a n d l a t e r a l (b) r a d i o

graphs of the left knee in a young patient with knee pain. There is a mixed lucent and sclerotic lesion of the distal femur with breach of the cortex medially and soft-tissue extension seen anteriorly and posteriorly (arrows). The location and appearances are consistent with osteosar

coma. Plain radiographs are important as a /f_i rst investigation MRI is best for local staging Bone scintigraphy or whole-body MRI for solitary or multiple lesion determination CT detects lung metastases Fluoroscopy, CT, MRI or ultrasound can be used to guide the biopsy

Aggressive bone disease

The radiograph is the first imaging technique for destructive lesions in bones. There is considerable experience required in the interpretation of these films, especially with regard to whether the lesion is benign or malignant ( Figure 8.24 calcification in tumours of muscle, tendon and subcutane - ous fat. When a lesion is detected, there needs to be an early decision as to whether this is benign or malignant. If there is a suspicion of malignancy on the radiograph, or any uncer - tainty , then local staging is indicated. This is best performed by MRI for both bone and soft-tissue lesions ( Figure 8.25 ) . At this stage, it is likely that a biopsy will be indicated, and preferably under image guidance. Soft-tissue and bone biopsy needles may be guided by CT , ultrasound or interventional MRI systems. The route of puncture should avoid vital struc - tures and must be agreed with the surgeon, who will perform local excision if the lesion proves to be malignant. Care should be taken to avoid contaminating other compartments. In all circumstances, samples are best sent for both histopathological and microbiological examination. It may be di ffi cult to tell on imaging whether or not a lesion is infected, and histology often provides a clear diagnosis in inflammatory conditions. Bone scintigraphy is useful in detecting whether a lesion is solitary or multiple, although whole-body MRI is becoming available. Summary box 8.11 Imaging of aggressive lesions in bone /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF

(a) Figure 8.24 A n t e r o p o s t e r i o r (a) a n d l a t e r a l (b) r a d i o

graphs of the left knee in a young patient with knee pain. There is a mixed lucent and sclerotic lesion of the distal femur with breach of the cortex medially and soft-tissue extension seen anteriorly and posteriorly (arrows). The location and appearances are consistent with osteosar

coma. Plain radiographs are important as a /f_i rst investigation MRI is best for local staging Bone scintigraphy or whole-body MRI for solitary or multiple lesion determination CT detects lung metastases Fluoroscopy, CT, MRI or ultrasound can be used to guide the biopsy