ARRS 2022 Abstracts

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E1716. A Systematic and Simplified Approach to Bone Tumors on Radiographs
Authors
  1. Paras Patel; Cooper University Hospital
  2. Justin Junus; Cooper University Hospital
Background
Unexpected musculoskeletal findings are incidentally noted on radiographs at a rate of 2–10%. Although most of these bone tumors are benign, asymptomatic, and occur 100x more than primary malignant tumors, some cannot be differentiated by imaging alone, particularly long bone lesions due to the high concentration of variable lesions. This can present as a diagnostic dilemma to residents, fellows, and practicing radiologists alike. However, there are signs and features that can help point the radiologist in the right direction and recommend the appropriate work up, ultimately helping the clinician in crucially differentiating malignant lesions from benign ones.

Educational Goals / Teaching Points
This exhibit’s educational goal is to provide a systematic and simplified approach to osseous lesions that are often first detected on radiographs, incidentally or symptomatically. The purpose is twofold; one is to give resident physicians and non-musculoskeletal trained radiologists a primer on how to handle these entities that may be foreign to them, specifically long bone lesions. We will go over osteoid, chondroid, and other mesenchymal lesions. Secondly, the purpose of this exhibit is to decrease unnecessary imaging work up by radiologists for lesions that are characteristically benign, while prompting further investigation for those that are characteristically malignant.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
This review will describe the fundamental pathophysiology processes of bone formation and destruction and how that translates to imaging (primarily on radiographs) and the next steps in management, whether that is “do not touch,” further workup with MRI, or biopsy. We will emphasize a pattern to pay attention to, including patient age, lesion location, margins, zone of transition, periosteal/endosteal reaction, matrix, and associated aggressive features. We will emphasize long bone lesions, as these are most commonly encountered. Imaging examples with key radiographic characteristics will accompany each lesion that is discussed.

Conclusion
Day to day practice for the radiologists, regardless of specialization, often involves reading musculoskeletal radiographs. It is common to come across incidental bone lesions. Without a systematic approach, this can lead to ordering unnecessary further work up for incidental findings or even symptoms (e.g., pain) unrelated to these bone lesions. Understanding benign, benign-aggressive, and malignant features on radiography in the appropriate clinical setting is critical for radiologists to make an appropriate differential diagnosis. By the end of this presentation, training and practicing radiologists alike should hopefully have a stronger grasp on categorizing bone lesions on radiography with a high degree of confidence.