Describing Bone Tumour X-rays


Pattern of bone destruction



- narrow transition from normal to abnormal bone

- margin of the lesion is well defined and easily separated from surrounding bone

- least aggressive

- usually indicative of slow growing lesions / benign tumours



- wider zone of transition from normal to abnormal

- less well defined lesional margin

- more aggressive

- characteristic of more rapidly growing lesion / malignant bone tumours & osteomyelitis



- wide zone of transition

- lesion is poorly demarcated

- not easily separated from surrounding normal bone

- aggressive bone lesion with rapid growth potential

- malignant tumours such as Ewing's


Visible tumour matrix



- chondromas, chondroblastoma, chondrosarcoma, chondromyxoid fibroma

- synovial sarcoma



- osteosarcomas, ossifying fibromas, osteomas, osteoblastomas


Ground Glass

- fibrous dysplasia


Cortical erosion


Enchondroma / chondrosarcoma

- can lead to endosteal scalloping & new periosteal bone may be laid down



- can expand the cortex rapidly


Malignant tumours

- can expand through cortex and lift periosteum


Periosteal response


Periosteal reaction

- slow growing tumour can evoke a periosteal response

- can get buttress at junction of normal & expanded bone


Onion skin pattern

- Ewing's

- multiple layers of periosteal new bone formation


Codman's triangle

- OS, Ewing's, infection

- lifting of periosteum at edge of lesion with bone formation


Sunburst pattern

- OS

- rays of periosteal bone formation radiating away from the bone


Hair on end

- Periosteal osteosarcoma


Soft Tissue Mass


Primary malignant bone neoplasm