What are the key points for X ray differentiation of benign and malignant bone tumors?

Hello: X-ray examination can provide valuable information for determining the nature, type, scope and decision of bone tumor, and is an important examination method for bone tumor. However, X-ray is only a projection of bone tumors, and the X-ray manifestations of bone tumors are not constant, and it is necessary to closely combine clinical manifestations and pathological examinations to make an accurate diagnosis.

Benign bone tumors have regular morphology, clear boundaries with surrounding normal bone tissue, bounded by hardened edges, bone cortex is thinned due to expansion, but still remains intact, no periosteal reaction, the image of malignant tumors is irregular, the edges are blurred, osteolytic phenomenon is more obvious, bone destruction, thinning, fracture, and loss, and primary malignant tumors often have periosteal reactions, and their shapes can be sunlight radiation, onion skin and Codman triangle.

1) Growth: benign growth is slow, does not invade adjacent tissues, but can cause compression and displacement, no metastasis. Malignant growth is rapid, easy to invade adjacent soft tissues, and metastasis.

2) Local bone changes: benign expansive changes, clear and sharp boundaries, thinning and intact bone cortex, and reactive osteosclerosis around the destruction area. Malignant is infiltrative bone destruction, blurred edges, no sclerosis, no expansion of the bone cortex, insect erosion destruction, interruption, and tumor.

3) Periosteal hyperplasia: benign generally without periosteal hyperplasia, which can occur after pathological fractures, and the new periosteal bone is continuous, without destruction or interruption. Malignant multimorphological periosteal hyperplasia, which can be destroyed or interrupted by osteoma to form the cuff sign.

4) Soft tissue changes: benign mostly without swelling and mass shadow. The edges of the malignant soft tissue mass are often blurred, and there may be tumor bone or calcifications within it.

The key points of X-ray differentiation between benign and malignant bone tumors are as follows.

Talking about limb benign bone tumors Malignant bone tumors.

The growth rate is slow and rapid.

Bone destruction Expansive, well-defined borders and infiltrative, with indistinct edges.

The periosteal reaction is usually unusual.

Changes in the cortex of the bone are thinned, continuous, blind, burned, destroyed, interrupted.

Soft tissue involvement Normal or Progressive invasion or formation of a mass.

Distant metastases are none.

Answers]: a, b, c, d

X-ray signs of malignant bone tumors: soft tissue mass shadow, rapid growth, invasion of close tissues, soft tissue swelling and swelling; There is a periosteal reaction, the tumor has no obvious boundary with normal tissue, and invades the soft tissue to make the swollen edge unclear; Bone cortex or intramedullary cavity destruction defects, less swelling and dilation. Intact or distentive changes in the bone cortex are x-ray signs of benign bone tumors.

a.Bone defect with well-defined margins and a pronounced periosteal response.

b.Bone destruction, unclear margins, and inconspicuous periosteal reaction.

c.Bone density is increased, the edges are not clear, and the bone and sail membrane are well reflexed.

d.Bone destruction, unclear margins, marked periosteal response (correct answer) eBone defects with well-defined margins and unresponsive periosteum.

Answer]: Benign bone tumors are mostly noticeable due to lumps, the pain is not obvious, the growth is slow, the X-ray boundary is clear, it is an exophytic or expansive bone lesion, the density is uniform, there can be sclerotic reaction bone around the lesion, the bone destruction is uniloculous or multilocular, there is no periosteal reaction, and the surrounding soft tissues are generally not invaded by the spine. Joint dysfunction can occur when the tumor is close to the joint.

Malignant bone tumors are mainly painful, with progressive aggravation, obvious pain at night, rapid development of swelling and masses, increased skin temperature, and superficial vein filling or distention. X-ray showed osteogenic, osteolytic or mixed bone destruction, uneven density and unclear boundaries of lesion refocus, insect moth-like or ethmoid hole shape in the bone destruction area, and obvious periosteal reactions such as Codman triangle, "onion skin" phenomenon and "sunlight ray" morphology were seen at the lesions, which often invaded the surrounding soft tissues and had a greater impact on the function of nearby joints.

Hello: X-ray examination can provide valuable information for determining the nature, type, scope and decision of bone tumor, and is an important examination method for bone tumor. However, X-ray is only a projection of bone tumors, and the X-ray manifestations of bone tumors are not constant, and it is necessary to closely combine clinical manifestations and pathological examinations to make an accurate diagnosis.

Benign bone tumors have regular morphology, clear boundaries with surrounding normal bone tissue, bounded by hardened edges, bone cortex is thinned due to expansion, but still remains intact, no periosteal reaction, the image of malignant tumors is irregular, the edges are blurred, osteolytic phenomenon is more obvious, bone destruction, thinning, fracture, and loss, and primary malignant tumors often have periosteal reactions, and their shapes can be sunlight radiation, onion skin and Codman triangle.

The CT findings of malignant bone tumors can be summarized as follows: (1) The interface between the lesion area and normal bone in most tumors is unclear and extensive. (2) The medullary cavity in most lesion areas was filled with tumor cells, and the interface was unclear.

3) The periosteal reaction is obvious, such as the green onion skin and the radial bone needle changes with the unclear interface with the bone cortex, which is difficult to distinguish from the cortex in severe cases. (4) The bone tumor expands and extends to the surrounding soft tissues, causing the surrounding soft tissues to swell and the fat gap to disappear, and it can be seen that the tumor tissue extends into the soft tissue in a lumpy shape, and the interface with the soft tissue is unclear, and the surrounding blood vessels are increased in a network on enhanced scanning. (5) In some cases, tumor cells can be seen beyond the cartilage plate on the articular surface, affecting the joint and adjacent bones.

6) Enhancement scans are mostly more obvious uneven or uniformly enhanced. (7) The lesion site is mostly tender and palpable with a hard mass.

Where bone cancer behaves differently on x-rays than other diseases:

1. The influence of the tumor on the host bone, whether the tumor and the host interosseous boundary is invasive or not is the primary factor to determine the nature of the lesion, and the clear boundary indicates that the tumor grows slowly and the infiltration is weak. Conversely, those with blurred boundaries indicate that the tumor is highly invasive.

2. The specific examination measures for bone cancer are the host's response to the tumor, the host always tries to destroy the tumor, wrap it, and form a fibrous tissue capsule, and the fast-growing tumor can infiltrate and destroy this reactive bone capsule, and only one or both ends of the tumor can see the remnants of this capsule, which is usually manifested as a Codman triangle.

3. The density of tumor tissue is also an examination measure for bone cancer, if there is any density change in bone tissue scintigraphy, it can be suspected that the tissue has lesions, some tumors are osteolytic lesions, such as bone giant cell tumor, and some are osteogenic lesions, osteogenic irregular or snowflake-like, such as osteosarcoma, chondrosarcoma.

The above is a detailed introduction to the tumor characteristics of bone cancer, and I hope you can understand this knowledge.

Benign anti-malfunction hyperbone tumors generally grow slowly and do not invade adjacent normal tissues, but they can be compressed to displace and deform, and a few can have compressive destruction. Ruler.

The scope of bone destruction is limited, the morphology is regular, and most of them are sac-like expansive destruction, with a clear demarcation from normal and hardened edges.

The cortex is generally intact and distensed, and the periosteum is generally unaffected, but the latter may be affected after a pathologic fracture or in cartilage myxoid fibromas.

Soft tissues are mostly absent from swelling or lumps. There is no transfer before the malignant transformation.