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Bony Lesions / Bone Tumor

Criteria that should be assessed when evaluating a bony lesion:

Demographics: lesions of bone have a specific propensity based on age and occasionally gender

Location: the location of the lesion within the skeleton is critical because specific lesions have a propensity to affect certain locations in the skeleton.

Longitudinal location: Most common tumor sites:

Epiphysis: chondroblastoma, giant cell tumor (GCT), aneurysmal bone cyst (ABC). GCT and ABC usually arise from the metaphysis and extend into the epiphysis.

Metaphysis: osteochondroma, chondrosarcoma, nonossifying fibroma, enchondroma (long bones), osteosarcoma, chondromyxoid fibroma, ABC, GCT.

Diaphysis: enchondroma (phalanges), osteoid osteoma, osteoblastoma, Ewing’s sarcoma, fibrous dysplasia.

Axial location: The location of the lesion should be defined as central intramedullary, eccentric intramedullary, cortically based, or surface (periosteal) centered.

Zone of transition: the transition zone between the lesion and the adjacent uninvolved bone should be classified as:

Narrow: well-defined margins that can be traced out with a pencil. This is a nonaggressive feature.

Wide or ill-defined: poorly defined margins, not easily traceable with a pencil. This is an aggressive feature.

Pattern of bone destruction: the pattern of bone replacement should be assessed and characterized as:

Geographic: well-defined lesion of bone. Geographic lesions have a narrow zone of transition by definition. This is a nonaggressive feature.

Blastic or sclerotic: densely sclerotic lesion of bone. Can be aggressive or nonaggressive

Permeative: ill-defined bony destruction. This is an aggressive feature.

Bubbly: multilocular lucencies, with or without expansile appearance. This is usually a nonaggressive feature.

Presence of matrix: If present, matrix falls into one of following categories:

Types of Nonaggressive Primary Bone Tumors by Matrix Appearance:





Unicameral bone cyst




Aneurysmal bone cyst

Fibrous dysplasia


Osteoid osteoma

Giant cell tumor



Eosinophilic granuloma

Chondromyxoid fibroma

Bone Tumor

Important determinators in the analysis of a potential bone tumor are:

  1. The morphology of the bone lesion on a plain radiograph

    • Well-defined osteolytic

    • ill-defined osteolytic

    • Sclerotic

  2. The age of the patient

--> the plain radiograph is the most useful examination for differentiating these lesions.
CT and MRI are only helpful in selected cases.





Bone Tumor Imaging


List of bone tumors and lesions - Radiology Assistant