Signs of bone damage on radiographs

2021-07-04 10:26 AM

When a tumor or lesion becomes infected, the inflammatory lesion affects the periosteum causing a reaction to form new bone from the inner surface of the periosteum.

Types of bone lesions are divided into 3 types related to contrast, structure, and shape, sometimes individually, sometimes in combination.

Abnormalities in contrast

The X-ray resistance of bone depends on the amount of calcium contained in a unit volume. This ratio is as valid as the cortical-medullary index measured at the tibia:

Decreased bone contrast: can only be seen on conventional radiographs when the amount of calcium decreases by at least 30%. Presented by a brighter (darker) appearance of surrounding healthy tissue, called osteoporosis. We have this process happening:

For all bones, in some general pathologies.

Locally in infections, parasites, tumors, trauma, in some other causes.

Increased bone contrast: when the calcium salt ratio increases, it is manifested by a blurred image (whiter) of surrounding healthy tissue, called solid bone. We meet bone density in the following cases:

Spread in blood disease, bone metastasis, thyroid dysfunction, heavy metal poisoning, bone syphilis, congenital bone diseases.

Focal: is a bone response to an injury or a disease with osteoblastic neoplasia.

Mixed contrast: both increase and decrease, often seen in chronic inflammatory processes, tumors, blood diseases...

Structural Abnormalities

Bone destruction process

The primary sign is a lacune if central, and erosion if peripheral. Inside there is no calcium, no or less contrast, but contains living or dead tissue.

Depending on the degree of destruction we have:

Osteoporosis or thinning of bones.

Bone destruction.

Bone resorption.

Osteonecrosis, with dead bone fragments.

Depending on the location:

If in the bone body, first think about cancer metastasis, tumor originating from blood, infection.

If in the medulla oblongata, think of the primary tumor first.

The bone head must first think of osteoclast tumor, chondroblastoma.

Concerning cartilage: synovial cartilage and articular cartilage form a barrier that prevents benign and malignant tumors from passing, whereas some infectious processes can pass through cartilage.

Concerning the cortical bone: it is necessary to take 2 poses at right angles to each other.

Morphology and size: can be oval, round, arc or multi-ring. Size indicates the progression of the lesion.

Borderline limitation: depends on growth rate and determines the condition of adjacent bone.

Solid limits: slowly progressive lesions (chronic infections, benign neoplasms).

Clear border: hole-like defect, no reaction around the lesion showing slow progression: Kahler disease, reticulosis disease

The halo border or discontinuity indicates a very rapidly progressing lesion (primary or secondary cancer, acute infection). Sometimes the border becomes very faint, difficult to see because of the many small defects (micro geodes), which are very rapidly progressing lesions of the primary malignancy.

Lesions: homogeneous, septate (usually osteoclasts, or encapsulated lesions). Spotted with small calcifications, suggestive of cartilage origin. The appearance of opacities in the center is usually chronic infection, dead bone, aseptic necrosis.

Bone building process

Osteogenic reaction:

It is the phenomenon of bone neoplasia that begins with the bone fibers. This process causes the bone to thicken and deform, which is reflected in the characteristics of morphology, position, border, invasion, and limitation of the induced bone reaction. Include:

Osteoarthritis: the entire bone fiber thickens, increasing the contrast.

Bone marrow.

Periosteal reaction:

When a tumor or lesion becomes infected, the inflammatory lesion affects the periosteum causing new bone formation from the inner surface of the periosteum. This neoplastic phenomenon of the periosteum creates the accretion pattern.

When the periosteum is destroyed in places and is pushed by the osteoclast genesis perpendicular to the major axis of the bone, creating spikes or burning grass is a manifestation of malignant lesions, rapidly progressing, invading both software. This symptom is evident on computed tomography or magnetic resonance imaging.

Mixing process

Both processes are commonly seen in some clinical diseases such as inflammation, bone tumors.

The isolated or multifocal nature of the lesion is a valuable factor for the diagnosis of local or systemic disease.

The process of osteomalacia

Accumulation of non-calcified bone-like components, soften bones and reduce mineralization of bone-like components. Commonly acquired due to vitamin D deficiency, also known as rickets; Congenital due to defects in metabolic enzymes or vitamin D resistance leads to a deficiency. On the image, we have bones with only skeletal structure, not ossified normally, or causing deformation of the temple roof, Trompette trumpet; deformity of the O-, X-, or baseball bat. 

Abnormal shape

In addition to deformities secondary to fracture, an injury to a long bone causes the bone to enlarge or shrink; changes in the bone shape or affects bone growth. Such deformity persists for months and years, giving the characteristic picture of the lesion:

The figure of a rotten tree: osteomyelitis.

Scabbard shape: solidified entire tibia in bony syphilis.

Golf stick shape: petrified bone disease...