Imaging of Bones and Joints by Klaus Bohndorf Mark W. Anderson Arthur Mark Davies

Author:Klaus Bohndorf,Mark W. Anderson,Arthur Mark Davies
Language: eng
Format: epub
Publisher: Thieme Medical Publishing Inc.
Published: 2016-03-18T16:00:00+00:00

4.1.4 Assessment of the Aggressiveness of a Bone Lesion: Growth Rate

Assessment of the aggressiveness of a bone lesion, its rate of growth, and its expansion within the bone is a critical contribution of imaging. This is based on a precise description of the bone lesion (see Chapter 4.1.3). Determining growth rate will often form the basis for differentiating between benign and malignant lesions, providing additional support for differential diagnostic criteria. This applies primarily to bone tumors and tumorlike lesions, but also to inflammatory conditions. Determination of the growth rate from the radiograph also aids the histological assessment of the bony process.

This is based on the classification system proposed by Lodwick that describes the bone destruction pattern visible on radiographs ( Fig. 4.8).

This classification system has two disadvantages, however: on the one hand, it is restricted to osteolytic lesions; on the other, grading into five groups is somewhat laborious for everyday clinical practice.

The following simplified classification may be of assistance for those less experienced in arranging the radiographic patterns into different categories and preparing the way for further diagnostic steps:

• Stage I: Osteolytic lesion with a circumscribed, sharply defined margin; nonaggressive, slow-growing, or even stationary growth (“latent”; Fig. 4.9a).

• Stage II: Osteolytic lesion still demarcated in every direction but with an ill-defined margin; intermediate growth or intermediate rate of expansion (“active”; Fig. 4.9b).

• Stage III: Moth-eaten or permeative pattern of bone destruction; aggressive growth, rapidly expanding lesion (“aggressive”; Fig. 4.9c).

An aggressive growth pattern, Stage III, is a typical feature of malignancy but can also be seen in acute osteomyelitis. Similarly, it is also possible for a metastasis to be surrounded by a sclerotic margin and thereby be classified as Stage I.

One insight gained from advances in diagnostic and molecular imaging techniques is the fact that reality, as seen on radiographs, is relative. One must always bear in mind that it is primarily a question of developing an overview of the pathophysiological processes that are taking place. As the American pathologist, James Ewing, postulated, it is necessary to grasp the “concept” of the disease.

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