Systematic Approach to Tumors and Focal Lesions of Bone

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Abstract

Bone neoplasms consist of mesenchymal tumors, hematopoietic tumors, and metastasis from mainly epithelial carcinomas. Also non-neoplastic bone lesions that mimic true tumors, including bone cysts and Langerhans cell histiocytosis, need to be included in the differential diagnosis. Classic analyses on tumor margin, mineralized matrix, and periosteal reaction, based on plain radiography, are important for differential diagnoses. CT provides greater morphological detail about the bone surrounding a lesion, and a similar analysis can be applied in the same way as classic radiographic margin analysis. MR imaging is particularly useful for preoperative staging of tumor extent and involvement of critical tissues such as joints, nearby neurovascular bundles, and muscles. In addition, it is particularly useful to evaluate aggressive lesions, with transcortical infiltration, a sign of highly aggressive lesions, and intertrabecular infiltration, a sign of focal infiltrative growth seen in malignant tumors. An “Aunt Minnie” approach often works, but radiologists have to approach non-specific or atypical lesions systematically.