Imaging of Bone Tumors and Tumor-Like Lesions (eBook)

MEDICAL RADIOLOGY Diagnostic Imaging 2
A. M. Davies · M. Sundaram · S. L. J. James (Eds.) 3
Techniques and Applications 3
Foreword 5
Preface 6
Contents 7
Bone Tumors: Epidemiology, Classification, Pathology 11
Introduction 12
Epidemiology 12
Morphologic Diagnosis of Bone Tumors 15
Types of Bone Tumor Specimens 16
Adjunctive Diagnostic Techniques 17
Classification of Bone Tumors 17
Comments on the Morphologic Classification of Bone Tumors 17
Congenital, Hereditary, and Non-hereditary Syndromes Associated with Bone Tumors 24
References 24
Computed Tomography of Bone Tumours 26
Introduction 26
Developments in Computed Tomography 27
Scan Image Quality 29
CT of Bone Tumours 33
Indications 33
CT-Guided Interventions 35
Conclusion 37
References 37
Imaging Techniques: Magnetic Resonance Imaging 39
Introduction 40
Technical Considerations 40
3.2.2.1 T1-weighted SE 41
3.2.2.2 T2-weighted Fast SE 42
3.2.2.3 Gadolinium-enhanced SE 43
3.2.2.4 Gradient Echo 45
3.2.2.5 STIR 46
3.2.4.1 Signal-to-Noise Ratio 47
3.2.4.2 Spatial Resolution 48
3.2.4.3 Scan Time 48
3.2.6.1 Quantitative Dynamic MR Imaging 48
3.2.6.2 Diffusion-weighted Imaging 49
3.2.6.3 MR Spectroscopy 50
Common MR Imaging Artifacts 50
Overview of MR Imaging in Bone Tumors 54
3.4.1.1 Fluid 55
3.4.1.2 Fluid-fluid levels 55
3.4.1.3 Edema 55
3.4.1.4 Hemorrhage 57
3.4.1.5N ecrosis 59
References 59
Nuclear Medicine 61
Introduction 62
PET and PET/CT 82
4.3.2.1 The Diagnosis and Grading of Bone Tumours 84
4.3.2.2 Staging of Sarcomas 85
4.3.2.3 Prognostic Indicator and Response to Therapy 86
4.3.2.4 Recurrence and Metastatic Disease 87
4.3.2.5 89
4.3.2.6 89
and PET/CT 89
References 90
Ultrasonography 93
Introduction 93
Imaging Features of Bone Tumours on Ultrasound 94
Morphological Features of Bone Tumours on Ultrasound 94
Tumour Characterisation 97
US-Guided Biopsy 98
Monitoring of Tumour Response 99
Assessment of Local Recurrence 100
Conclusion 101
References 101
Interventional Techniques 102
Introduction 102
Thermal Ablation 103
Cementoplasty 106
Bone Substitutes 112
Embolization 113
References 114
Principles of Detection and Diagnosis 117
Introduction 117
Detection 118
Diagnosis 123
7.3.1.1 Site in Skeleton 125
7.3.1.2 Location in Bone 126
7.3.1.3 Pattern of Bone Destruction 130
7.3.1.4 Periosteal Reaction 132
7.3.1.5 Tumour Mineralisation 137
Conclusion 141
References 141
Biopsy 144
Introduction 145
Planning of Biopsy 145
8.2.2.1 Lesion Selection 148
8.2.2.2 Biopsy Method 148
8.2.3.1 Fluoroscopy 151
8.2.3.2 Ultrasonography 151
8.2.3.3 MR Imaging 152
8.2.3.4 CT Fluoroscopy 152
8.2.4.1 Axial Skeleton 153
8.2.4.2 Appendicular Skeleton 154
Procedure 159
8.3.3.1 US-Guided Biopsy 160
8.3.3.2 CT-Guided Biopsy 160
8.3.3.3 Spinal Biopsy 162
Conclusion 165
References 165
Surgical Staging 1: Primary Tumour 168
Introduction 169
Bone Tumour Staging Systems 169
Staging of Long Bone Tumours 171
Staging of Tumours of the Shoulder Girdle 181
Staging of Tumours of the Bony Pelvis 183
Conclusion 185
References 185
Surgical Staging 2: Metastatic Disease 187
Introduction 188
Sites of Metastatic Spread 188
Imaging Evaluation 195
Conclusion 199
References 199
Assessment of Response to Chemotherapy and Radiotherapy 202
Introduction 203
Assessment of Response to Radiotherapy 203
Assessment of Response to Chemotherapy 203
11.3.4.1 Changes in Extramedullary Tumour 204
11.3.4.2 Change in the Bone Marrow Component 205
11.3.5.1 Practical Guidelines 206
11.3.5.2 Physiological Background 206
11.3.5.3 Post-processing Methods 211
11.3.5.4 Assessment of Response 211
References 212
Assessment of Locally Recurrent Disease 214
Introduction 214
Imaging Modalities 214
Imaging Findings 215
Benign Tumors 215
Malignant Tumors 219
Conclusion 224
References 225
Cartilage Tumours 227
Introduction 227
Chondroblastoma 228
Chondroma 230
13.3.3.1 Maffucci’s Disease 234
Osteochondroma 234
Chondromyxoid Fibroma 236
Chondrosarcoma 238
13.6.1.1 Conventional Chondrosarcoma 239
13.6.1.2 Clear Cell Chondrosarcoma 241
13.6.1.3 Mesenchymal Chondrosarcoma 243
13.6.1.4 Juxtacortical Chondrosarcoma 243
Differential Diagnosis: Enchondroma Versus Low-grade Chondrosarcoma 248
References 250
Osseous Tumors 253
Abstract 254
Introduction 254
Benign Osseous Tumors 255
14.2.1.1 Pathology 255
14.2.1.2 Clinical Presentation 255
14.2.1.3 Imaging 255
14.2.1.4 Giant Bone Island 257
14.2.1.5 Natural History 259
14.2.2.1 Pathology 259
14.2.2.2 Clinical Presentation 260
14.2.2.3 Imaging 260
14.2.2.4 Gardner Syndrome 262
14.2.3.1 Pathology 263
14.2.3.2 Classification 264
14.2.3.3 Clinical Presentation 264
14.2.3.4 Skeletal Distribution 265
14.2.3.5 Imaging 266
14.2.3.6 Natural History 270
14.2.3.7 Treatment 271
14.2.4.1 Pathology 271
14.2.4.2 Classification 272
14.2.4.3 Clinical Presentation 272
14.2.4.4 Skeletal Distribution 272
14.2.4.5 Imaging 273
14.2.4.6 Treatment 276
Osteosarcoma 276
Intramedullary Osteosarcoma 279
14.4.1.1 Radiography 280
14.4.1.2 Scintigraphy 280
14.4.1.3 CT Scanning 281
14.4.1.4 MR Imaging 281
14.4.1.5 Treatment 285
14.4.2.1 Telangiectatic Osteosarcoma 285
14.4.2.2 Small Cell Osteosarcoma 287
14.4.2.3 Gnathic Osteosarcoma 289
14.4.2.4 Low Grade Intraosseous Osteosarcoma 290
Juxtacortical Osteosarcoma 290
Secondary Osteosarcoma 297
Summary 301
References 302
Fibrogenic and Fibrohistiocytic Tumors 309
Introduction 310
Desmoplastic Fibroma 310
Fibrosarcoma 312
Benign Fibrous Histiocytoma 313
Nonossifying Fibroma/Fibrous Cortical Defect 315
Malignant Fibrous Histiocytoma 317
References 319
Giant Cell Tumor 322
Introduction 322
Clinical Features 323
Skeletal Distribution 323
Classification and Pathologic Features 325
Treatment and Prognosis 326
Imaging 326
Malignant Giant Cell Tumor 331
Multifocal Giant Cell Tumor 334
Conclusion 335
References 335
Ewing Sarcoma/PNET Tumors 338
Introduction 339
Incidence 339
Age 339
Location 339
Clinical and Laboratory Findings 342
Imaging Features 344
Histology 347
Differential Diagnosis 347
Staging Evaluation 347
Prognostic Factors 348
Treatment 349
Conclusion 349
References 349
Hematopoietic Tumors 351
Introduction 351
Chronic Myeloproliferative Diseases 352
Myelodysplastic Syndromes 354
Acute Myeloid Leukemia 354
Precursor B-cell and T-cell Neoplasms 355
B-Cell Neoplasms 355
Lymphoma 359
References 362
Angiomatous Neoplasms of the Skeletal System 364
Introduction 364
Classifications 365
Biological and Clinical Behavior 365
Radiological and Pathological Manifestation 366
Conclusion 371
References 371
Notochordal Tumours 373
Introduction 373
Notochordal Remnants 374
Benign Notochordal Cell Tumours 374
Incipient Chordoma 378
Classic Chordoma 379
Chondroid Variant of Classic Chordoma 386
Dedifferentiated Chordoma 387
Extra-Axial Chordoma 387
Conclusion 387
References 388
Smooth Muscle Tumors 391
Introduction 391
Primary Bone Leiomyosarcoma 391
Bone Leiomyoma 396
References 396
Lipogenic Tumours of Bone 398
Introduction 398
Intraosseous Lipoma 398
22.2.3.1 Radiographic Features 400
22.2.3.2 Cross-Sectional Imaging 400
22.2.3.3 Differential Diagnosis 402
Parosteal Lipoma 404
Intraosseous Liposarcoma 406
References 407
Fibrous Dysplasia, Osteofibrous Dysplasia, and Adamantinoma 408
Introduction 408
Fibrous Dysplasia 409
23.2.2.1 Monostotic Fibrous Dysplasia 409
23.2.2.2 Polyostotic Fibrous Dysplasia 410
23.2.2.3 McCune-Albright Syndrome 410
23.2.2.4 Mazabraud’s Syndrome 410
23.2.2.5 Malignancy in Fibrous Dysplasia 410
23.2.2.6 Low-Grade Central Osteosarcoma Mimicking Fibrous Dysplasia 411
23.2.2.7 Cystic Fibrous Dysplasia 413
23.2.2.8 Fibrous Dysplasia Protuberans 413
23.2.3.1 Long Bones 414
23.2.3.2 Craniofacial Bones 414
23.2.3.3 Additional Skeletal Locations 415
23.2.3.4 Other Imaging Modalities 415
Osteofibrous Dysplasia 417
Adamantinoma 418
References 420
Cystic Lesions of Bone 422
Simple Bone cyst 423
24.1.9.1 Radiographs 424
24.1.9.2 CT 425
24.1.9.3 MR Imaging 425
24.1.9.4 Bone Scintigraphy 426
24.1.10.1 Aneurysmal Bone Cyst 427
24.1.10.2 Fibrous Dysplasia 427
24.1.10.3 Sarcoma 427
Aneurysmal Bone Cyst 427
24.2.5.1 Appendicular Skeleton 428
24.2.5.2 Axial Skeleton 428
24.2.6.1 Appendicular Skeleton 428
24.2.6.2 Axial Skeleton 429
24.2.8.1 Radiographs 430
24.2.8.2 CT 431
24.2.8.3 MR Imaging 431
24.2.8.4 Bone Scintigraphy 432
24.2.8.5 Imaging: Axial Skeleton 432
24.2.8.6 Imaging: Surface ABC 432
24.2.8.7 Imaging: Solid ABC 433
24.2.8.8 Imaging: Secondary ABC 433
24.2.10 Difficulties in Obtaining Histological Diagnosis 435
Intraosseous Ganglion 435
24.3.9.1 Radiographs 438
24.3.9.2 CT 438
24.3.9.3 MR Imaging 438
24.3.9.4 Bone Scintigraphy 439
Miscellaneous Bone Cysts 439
References 440
Langerhans Cell Histiocytosis 444
Introduction 444
Nomenclature and History 445
Pathogenesis 445
Incidence 446
Clinical Presentation 446
Treatment 447
Skeletal Disease 448
25.7.1.1 Skull and Mandible 448
25.7.1.2 Other Flat Bones 448
25.7.1.3 Spine 448
25.7.1.4 Long Bones 449
Extraosseous Involvement 451
Investigation of Patients 454
References 454
Bone Metastases 1: Spine 457
Introduction 457
Pathophysiology of Spinal Metastases 458
Clinical Features of Spinal Metastases 459
Imaging Features of Spinal Metastases 460
Algorithmic Approach 469
Differential Diagnosis 470
Biopsy 472
Management/Therapy 472
References 474
Bone Metastases 2: Pelvis and Appendicular Skeleton 476
Introduction 477
Definition 477
Epidemiology 477
Pathophysiology 477
Imaging Modalities 484
Clinical Considerations 489
Differential Diagnosis 492
Biopsy 493
Tumour-Specific Considerations 494
Treatment Options 494
Fracture Risk 495
Further Imaging/Follow-up 495
Conclusion 496
References 496
Radiation-Induced Tumours 498
Introduction 498
Historical Perspective 499
Microscopic Effects of Radiation on Bone 500
Radiation-Induced Bone Tumours 500
Tumour-Like Complications of Radiation 506
Conclusion 508
References 508
Tumour and Tumour-like Conditions Associated with Paget’s Disease of Bone 510
Introduction 510
Malignant Tumours 511
29.2.1.1 Incidence 511
29.2.1.2 Aetiology 511
29.2.1.3 Site 511
29.2.1.4 Histology 512
29.2.1.5 Radiographic and Computed Tomographic Features 513
29.2.1.6 Scintigraphic Features 514
29.2.1.7 Magnetic Resonance Features 515
29.2.1.8 Prognosis 515
Benign Tumours 519
Tumour-Like Conditions 520
Conclusion 522
References 523
Reactive, Metabolic, and Tumor-Like Lesions of Bone 526
Metabolic Bone Diseases 527
30.1.1.1 ‘Benign’ versus ‘Malignant’ Vertebral Fractures 527
30.1.1.2 Disuse Osteoporosis versus Neoplasm 532
30.1.1.3 Insufficiency Fractures and Pubic Osteolysis: Mimics of Malignancy 533
30.1.1.4 Osteogenesis Imperfecta Type V 534
30.1.2.1 The Radiologist and Oncogenic Osteomalacia 535
30.1.3.1 Brown Tumors 538
30.1.3.2 Amyloidomas of the Bone and Renal Spondyloarthropathy 539
Reactive and Tumor-Like Lesions of the Bone 540
Conclusions 545
References 545
Tumours of the Ribs and Clavicle 548
Tumours of the Clavicle 548
Ribs 551
Sternal Tumours 555
References 556
Scapula 558
Introduction and Background 559
32.1.1.1 Investigations 559
32.1.1.2 Biopsy 560
32.1.1.3 Surgery 561
32.1.1.4 Post-operative Surveillance 562
Benign Bone Tumor of Scapula 565
Malignant Bone Tumors of Scapula 572
Extraosseous Tumor with Overt Secondary Bone Destruction of Scapula 576
Bone Pseudotumors of Scapula 576
Benign Systemic Disorders which May Involve the Scapula 577
32.6.5.1 Synovial Chondromatosis 578
32.6.5.2 Rheumatological and Degenerative 578
32.6.5.3 Crystal Arthropathies 578
Extraosseous Tumors Related to/with Impact on the Scapula 578
Conclusion 578
References 579
Anatomical Considerations: Spine and Sacrum 582
Introduction 583
Metastases 583
Overview of Primary Pediatric Bone Tumors 583
Benign Lesions in the Pediatric Population 583
33.4.4 Osteochondroma 585
Malignant Lesions in the Pediatric Population 587
Benign Lesions in Adults 589
Malignant Tumors in Adults 592
References 595
Bony Pelvis 597
Introduction 597
Imaging Bone Tumours and Tumour-like Lesions 598
34.2.3.1 Location 599
34.2.3.2 Radiographic Features 599
34.2.3.3 Cross-sectional Imaging 601
Benign Bone Tumours and Tumour-like Lesions 603
Malignant Bone Tumours 607
References 611
Hand and Wrist 614
Introduction 614
Benign Tumours 615
Bone-Forming Surface Lesions 621
Miscellanous Lesions 622
Malignant Tumours 623
Conclusion 627
References 627
Tumours and Tumour-Like Lesions of the Patella 630
Introduction 630
Benign Tumours 631
Malignant Tumours 633
Tumour-Like Lesions 634
References 638
Tumours of the Foot 640
Introduction 640
Imaging Tumours and Tumour-like Lesions 641
37.2.3.1 Location 642
37.2.3.2 Radiographic Features 644
37.2.3.3 Cross-sectional Imaging 644
Benign Tumours and Tumour-like Lesions 646
Malignant Bone Tumours 651
References 656
Compartmental Anatomy 658
Relevance of Compartmental Anatomy to Grading of Bone Tumors 658
Compartmental Anatomy of the Upper and Lower Extremity 659
Relevance of Compartmental Anatomy to Biopsy Approach 668
References 669
Who Was Who in Bone Tumours 670
Introduction 670
Biographies 671
Subject Index 680
List of Contributors 686
MEDICAL RADIOLOGY 692