X-ray may be helpful in the diagnosis of fibroma. Findings on x-ray suggestive of a particular fibroma depends on the type of the fibroma. Findings on x-ray suggestive of non-ossifying fibromas include sharply demarcated, asymmetrical, and cortically based lucencies with a thin sclerotic rim. Findings on x-ray suggestive of ossifying fibroma include well-circumscribed lesion, intracortical osteolysis with a characteristic sclerotic band, cortical expansion, and a lytic thinning of the diaphyseal cortical bone with interspersed sclerosis. Findings on x-ray suggestive of chondromyxoid fibroma include a lobulated, eccentric radiolucent lesion. Findings on x-ray suggestive of desmoplastic fibroma include a lytic bone lesions with a geographic pattern of bone destruction and a narrow zone of transition and non-sclerotic margins.

• The following radiographic features are noted on x-ray of ossifying fibroma:^[1]
  • Ossifying fibroma is seen as a well-circumscribed lesion
  • Ossifying fibroma demonstrates evidence of intracortical osteolysis with a characteristic sclerotic band
  • Cortical expansion
  • Radiographic features of ossifying fibroma include a lytic thinning of the diaphyseal cortical bone with interspersed sclerosis.^[2]

• The following features are seen on plain radiograph of chondromyxoid fibromas:^[3]
  • Chondromyxoid fibroma is seen as a lobulated, eccentric radiolucent lesion
  • Long axis is parallel to long axis of long bone
  • No periosteal reaction (unless a complicating fracture present)
  • In approximately 100% of cases geographic bone destruction is present
  • In approximately 85% of cases well defined sclerotic margin is present
  • In approximately 60% of cases there can be presence of septations (pseudo trabeculation)
  • In approximately 12.5% there can be presence of matrix calcification

• The following features are seen on plain radiograph of desmoplastic fibromas:^[4]
  • Desmoplastic fibroma are typically seen as a lytic bone lesions with a geographic pattern of bone destruction
  • It often has a narrow zone of transition and non-sclerotic margins
  • In approximately more than 90% of cases internal pseudo trabeculation is present
  • Matrix mineralization is not present
  • In approximately 90% of cases widening of the host bone from gradual apposition of periosteal new bone formation is seen

• The following features are seen on plain radiograph of pleural fibromas:^[5]
  • On x-ray pleural fibromas presents as a pleural based mass. They tend to be relatively circumscribed and can sometimes be lobulated. It often forms an obtuse angle with the chest wall. Tumors may grow to a large size. Pedunculated lesions can change position and appearance with respiration or with a change in position. Calcification, rib destruction, and pleural effusions are typically not associated features.

• The following features are seen on plain radiograph of cemento-ossifying fibromas:^[6]
  • Cemento-ossifying fibroma are usually well circumscribed masses which expand the underlying bone. They are usually small, but can become large. This is particularly the case when they arise from the maxilla or paranasal sinuses because there is more room to expand.
  • They are initially lucent on x-ray. As they mature, they gradually develop increasing amounts of calcification/ossification as they mature. They usually expand the bone without cortical breach.

• On x-ray popcorn calcification within the pelvis may suggest the diagnosis of uterine fibromas.

• On x-ray, non-ossifying fibromas are characterized by sharply demarcated, asymmetrical, cortically based lucencies with a thin sclerotic rim.^[7]
• They often appear multiloculated. They are located in the metaphysis, adjacent to the physis. As the patient ages, they seem to migrate away from the growth plate.
• They have no associated periosteal reaction, cortical breach or associated soft tissue mass.
• Nonossifying fibroma appear as well defined, small, eccentric, lytic, expansile lesions located in the metaphysis with scalloped sclerotic borders. Multiple lesions may be present.

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