Aggressive vs non-aggressive bone lesions (radiographs)

Last revised by Yaïr Glick on 29 Sep 2022

Citation, DOI, disclosures and article data

Citation:

Lustosa L, Glick Y, Weerakkody Y, et al. Aggressive vs non-aggressive bone lesions (radiographs). Reference article, Radiopaedia.org (Accessed on 25 Apr 2024) https://doi.org/10.53347/rID-97258

DOI:

https://doi.org/10.53347/rID-97258

Permalink:

https://radiopaedia.org/articles/97258

rID:

97258

Article created:

8 Feb 2022, Leonardo Lustosa ◉

Disclosures:

At the time the article was created Leonardo Lustosa had no recorded disclosures.

View Leonardo Lustosa's current disclosures

Last revised:

29 Sep 2022, Yaïr Glick ◉

Disclosures:

At the time the article was last revised Yaïr Glick had no financial relationships to ineligible companies to disclose.

View Yaïr Glick's current disclosures

Revisions:

5 times, by 4 contributors - see full revision history and disclosures

Systems:

Musculoskeletal

Tags:

aggressive, non-aggressive, nonaggressive, vs, bone lesion, bone lesions, bone tumor, bone tumour, aggressiveness, malignancy

Synonyms:

Aggressive versus nonaggressive bone lesions
Aggressiveness of bone lesions
Bone lesion aggressiveness
Nonaggressive vs aggressive bone lesions
Nonaggressive versus aggressive bone lesions

Bone lesions are generally characterized as either aggressive versus non-aggressive bone lesions, with radiographs comprising much of the initial assessment.

Imaging features

When describing a bone lesion, some of its features reflect its biological activity. These characteristics include zone of transition (margins), cortical involvement, and periosteal reaction.

Other features, such as location in the skeleton, location within the bone, pattern (i.e. lytic, sclerotic, and mixed), and matrix, aren't directly related to aggressiveness but allow for a better description of the bone lesion and may help to diagnose the lesion and thus know its behavior (e.g. a lytic epiphyseal lesion is likely to be a giant cell tumor or a chondroblastoma)

Zone of transition

The margins of a lesion may present in some distinct appearances, each of them reflecting different spectra of potential aggressiveness.

well-defined lesions with a sclerotic rim are the least aggressive
well-defined lesions without a sclerotic rim can be seen both in benign and malignant lesions, having an indeterminate biological potential
ill-defined lesions with a wide zone of transition are seen in aggressive bone lesions
moth-eaten appearance and permeative lesions are related to aggressive lesions

Cortical involvement

Cortical expansion (or insufflation) can be seen on some aggressive benign bone tumors. Proper cortical destruction usually indicates an aggressive malignant tumor.

Periosteal reaction

If there is periosteal reaction near a bone lesion, it may be classified into aggressive or non-aggressive, usually related to the underlying bone lesion. Similar to the margins aspect, each periosteal reaction appearance reflects a different spectrum of aggressiveness.

non-aggressive
- thin
- solid
- thick irregular
aggressive
- laminated/lamellar: single or multilayered (onion skin appearance)
- spiculated: perpendicular (hair-on-end) or divergent (sunburst appearance)
- disorganized
- Codman triangle

Clinical features

Alongside imaging characteristics, some clinical features are useful for narrow ing down differential diagnoses, especially the patient's age. An adequate history is an important stage for the diagnosis of a bone lesion.