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Health Dictionary

Reliable, easy-to-read patient information on common medical conditions — written in plain language, free of jargon, and grounded in current evidence. Browse the most frequent diagnoses, understand what they mean for everyday life, and learn which steps and questions help you have a focused conversation with your doctor.

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Osteosarcoma x ray

Introduction

Overview

Overview

On X-ray, osteosarcoma is characterized by medullary and cortical bone destruction, periosteal reaction, tumor matrix calcification, and soft tissue mass.

X Ray

X Ray

Conventional radiography continues to play an important role in diagnosis of osteosarcoma. Typical appearances of conventional high grade osteosarcoma include:[1][2][3][4][5][6][7]

  • Sunburst appearance
  • Codman triangle
  • Lamellated (onion skin) reaction: less frequently seen
  • Variable: reflects a combination of the amount of tumor bone production, calcified matrix, and osteoid.
  • Ill-defined fluffy or cloud-like cf. to the rings and arcs of chondroid lesions.
  • The following table illustrates the findings on x-ray for the subtypes of osteosarcoma:[1]
Subtype X-Ray findings
Intracortical osteosarcoma
  • Presents as an oval intracortical geographic osteolytic lesion in the diaphysis with surrounding sclerosis.
  • Measures approximately 4 cm in length.
  • Multiple calcific foci can be seen within the lytic region, suggesting osteoid matrix.
Parosteal osteosarcoma
  • Large lobulated exophytic, ‘cauliflower-like’ mass with central dense ossification adjacent to the bone.
  • String sign: Thin radiolucent line separating the tumor from cortex, observed in 30% of cases.
  • Tumor stalk: Grows within tumor in late stages and obliterates the radiolucent cleavage plane.
  • +/- soft tissue mass.
  • Cortical thickening without aggressive periosteal reaction is often seen.
  • Tumor extension into medullary cavity is frequently observed.
Periosteal osteosarcoma
  • Typically seen as a broad-based surface soft-tissue mass causing extrinsic erosion of thickened underlying diaphyseal cortex and perpendicular periosteal reaction extending into the soft-tissue component.
Telangiectatic osteosarcoma
  • Typically seen as an expansile lytic metaphyseal bony lesion.
  • Geographic bony destruction with wide zone of transition tends to be more common than permeative bony destruction.
  • Less osteoid matrix compared to conventional type.
Low grade osteosarcoma
  • Because the fibrous dysplasia and central low-grade osteosarcoma are so similar histologically, the radiographic features are an extremely important part of the diagnosis.
  • Radiographic features of low-grade osteosarcomas are variable.
  • Most common pattern is as a large intracompartmental expansile lytic fibro-osseous lesion with coarsely thick or thin incomplete trabeculations. Another less common pattern is as a sclerotic lesion.
  • Cortical erosion and soft tissue extension is also a common feature.
Extra skeletal osteosarcoma
  • Soft tissue density with a variable amount of calcification which represents osteoid matrix formation, and is seen in approximately 50% of cases.
References

References

  1. ↑ 1.0 1.1 Osteosarcoma. Dr Amir Rezaee ◉ and Dr Frank Gaillard ◉ et al. Radiopaedia.org 2015. http://radiopaedia.org/articles/osteosarcoma
  2. ↑ Gürtler KF, Riebel T, Beron G, Heller M, Euler A (April 1984). “[Comparison of x-ray plain films, x-ray tomograms and computed tomograms in lung nodules in children and adolescents]”. Rofo (in German). 140 (4): 416–20. doi:10.1055/s-2008-1052998. PMID 6425164.
  3. ↑ Riebel T, Knop J, Winkler K, Delling G (October 1986). “[Comparative x-ray and nuclear medical studies of osteosarcomas to evaluate the effectiveness of preoperative chemotherapy]”. Rofo (in German). 145 (4): 365–72. doi:10.1055/s-2008-1048952. PMID 3022331.
  4. ↑ Dinkel E, Uhl H, Roeren T (April 1985). “[Lung metastases–limitations and possibilities of radiologic diagnosis]”. Radiologe (in German). 25 (4): 158–65. PMID 3889998.
  5. ↑ Kesselring FO, Penn W (1982). “Radiological aspects of ‘classic’ primary osteosarcoma: value of some radiological investigations: A review”. Diagn Imaging. 51 (2): 78–92. PMID 7042255.
  6. ↑ Kubo T, Furuta T, Johan MP, Adachi N, Ochi M (September 2016). “Percent slope analysis of dynamic magnetic resonance imaging for assessment of chemotherapy response of osteosarcoma or Ewing sarcoma: systematic review and meta-analysis”. Skeletal Radiol. 45 (9): 1235–42. doi:10.1007/s00256-016-2410-y. PMID 27229874.
  7. ↑ Rothermundt C, Seddon BM, Dileo P, Strauss SJ, Coleman J, Briggs TW, Haile SR, Whelan JS (May 2016). “Follow-up practices for high-grade extremity Osteosarcoma”. BMC Cancer. 16: 301. doi:10.1186/s12885-016-2333-y. PMC 4859955. PMID 27154292.

Editor-In-Chief:
C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohammadmain Rezazadehsaatlou[2]