Key points in the evaluation of focal bone lesions: from plain film to multidetector CT
|
|
- Howard Edwards
- 5 years ago
- Views:
Transcription
1 Key points in the evaluation of focal bone lesions: from plain film to multidetector CT Poster No.: C-2060 Congress: ECR 2011 Type: Educational Exhibit Authors: I. Rubio Marco, M. Arraiza Sarasa, H. Gómez Herrero, A. De Blas Mendive, I. García de Eulate, C. De Arriba Villamor, A. Ovelar Ferrero, M. Tirapu Tapiz; Pamplona/ES Keywords: Diagnostic procedure, Conventional radiography, CT, Musculoskeletal bone DOI: /ecr2011/C-2060 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. Page 1 of 35
2 Learning objectives To review the features that should be evaluated to radiographically differenciate aggressive from non-aggressive focal bone lesions and try to characterize them with plain film and multidetector CT. To identify the main advantages and limits of each technique. To ilustrate this review with some cases studied in our institution. Page 2 of 35
3 Background Radiologists play a key role in the detection and characterization of focal bone lesions. Bone tumors are relatively uncommon in general radiological practice and they show varied appearances, so it is crucial to evaluate the images in a systematic manner to lead to a short differential diagnosis list, guiding the further management of these patients. Conventional radiography is the first-line imaging technique in the evaluation of patients with bone tumors. In the 1960s, Dr. Gwilym Lodwick, professor of radiology, introduced a systematic approach to the radiological diagnosis of bone tumors that is still used today with some more recent contributions, as we will see later. A lot has been said and written about the analysis of focal bone lesions with conventional radiography but not too much with computed tomography (CT). In this exhibit we will review the fundamental radiographic principles in bone tumor diagnosis and the correlation between plain film and CT images, emphasizing on the aditional information provided by the last one. Page 3 of 35
4 Imaging findings OR Procedure details The diagnostic approach to focal bone lesion should include: Clinical information Number of lesions (solitary or multiple) Location Morphologic features 1. Clinical information: The age of the patient is the most important piece of clinical information because the majority of bone lesions show predilection for a specific age range: <20, and >40 years old. Page 4 of 35
5 Fig.: Group age predilection of bone lesions References: Miller T. Radiology 2008; 246: Most primary bone tumors develop in childhood, late adolescence or early adulthood, coinciding with the growth spurt and the time of maximal metabolic activity of bone. Some other parameters that should be evaluated are family history (eg, hereditary multiple osteochondromatosis, neurofibromatosis), past history (eg, evaluation of metastatic disease) and history of presenting complaint (eg, swelling, characteristics of pain...). Laboratory data (eg, alkaline and acid phosphatases, PSA levels, neutrophilia...) may also provide useful information. Page 5 of 35
6 2. Number of lesions: Benign and malignant lesions can be multiple. Benign multiple tumors include polyostotic fibrous dysplasia, enchondromatosis, multiple osteochondral exostoses, Langerhans cells granulomatosis and some more. When malignant multiple bone lesions, they are commonly caused by metastases, multiple myeloma or lymphoma. 3. Location: Certain tumors have predilection for specific bones or specific locations within bones. Fig.: Preferential localization of bone tumors in the skeleton Page 6 of 35
7 References: Differential Diagnosis of Tumors and Tumor-like lesions of Bones and Joints. Adam Greenspan, Wolfgang Remagen Fig.: Specific sites of selected tumors References: Bone Tumors and Tumorlike Conditions: Analysis with Conventional Radiography. Miller T. Radiology 2008; 246: Differential Diagnosis of Tumors and Tumors-like lesions of Bones and Joints. Adam Greenspan, Wolfgang Remagen Within long bones, the radiologist must determine the location in the longitudinal (epiphysis*, metaphysis and diaphysis) and axial (intramedullary, intracortical and surface or juxtacortical -the last ones include parosteal and periosteal lesions-) planes. However, in short or thin tubular bones, such us the metacarpals or phalanges, the entire diametre of the bone can be involved, sometimes making it difficult to determine in which part of the bone the lesion started. Page 7 of 35
8 *An apophysis is equivalent to an epiphysis because both of them are growth centers (the first one does not contribute to the length of a bone and the second one does). Most primary bone lesions are metaphyseal and intramedulary, probably because the metaphysis is the most metabolically active and most vascular area in a growing long bone. Fig.: Common location of tumors and tumorlike bone lesions. Based on the diagram published by Miller, AJR 2009 Vol 246 Num 3 4. Morphologic features: Page 8 of 35
9 a. Patterns of bone destruction: They reflect the growth rate rather than the malignant potential of the lesion. The patterns may range from a discrete well-defined abnormality to an ill-defined infiltrative process. Fig.: Patterns of bone destruction. geographic destruction (type I): bony destruction is confined to one area within which all bone is destroyed. These are slow-growing lesions. Based on their aggressiveness they are subclassified in three groups: - type Ia (sharp margins with thick sclerotic rim), usually benign. Page 9 of 35
10 Fig.: Type 1a geographic bone lesion. Page 10 of 35
11 Fig.: Type 1a geographic lesion. - type Ib (sharp margins without sclerotic rim), usually benign. Page 11 of 35
12 Fig.: Type 1b geographic lesion. Page 12 of 35
13 Fig.: Type 1b geographic bone lesion. - type Ic (ill-defined margins), usually malignant moth-eaten destruction (type II): multiple clustered foci of bone destruction, each one 2-5 mm size. This pattern reflects a lesion that grows rapidly through the medula of the bone but leaves small islands of tissue intact. permeative (type III): multiple ill-defined destructive foci, usually smaller than 1 mm in diameter. This pattern reflects fast-growing lesions. Page 13 of 35
14 Fig.: Type 3 permeated lytic lesion. combination and changing pattern: characterised by a combination of typei, type II and type III in a single lytic lesion and suggests more aggressive local growth. This pattern is usually seen in some benign lesions when they become active, undergo malignant change or fracture. However, while a non-aggressive appearance suggests a benign lesion and an aggressive appearance suggests a malignant one, it is not always the case b. Periosteal reaction: Page 14 of 35
15 Periosteal reaction results when cortical bone reacts to one of many possible insults (trauma, congenital disease, arthritis, metabolic disorders, infection, tumors...). It is another indicator of the biological activity of the lesion as its appearance is determined by the intensity, aggressiveness and duration of the underlying insult. Thus, intense, rapid-acting processes usually result in aggressive periosteal reaction, whereas slower, indolent result in a non-aggressive appearance, regardless of being benign or malignant. One has to bear in mind that the periosteum in children is more active and less adherent to the cortex than in adults, so periosteal reaction can occur earlier and appear more aggressive. The terminology used to describe periosteal reactions is confusing because many terms have been used. In 1965 Lodwick described two "proliferative responses": encapsulated and mottled. In 1966 Edeiken coined the term "periosteal reaction" and described continuous and interrupted forms. To summarize, we can consider two major groups: aggressive and non-aggressive. Page 15 of 35
16 Fig.: Types of non-aggressive and aggressive periosteal reaction. (Based on AJR:193, October 2009) The major goal in evaluating periosteal reaction is to recognize its presence rather than the specific subtype because there is significant overlap in the disease entities that result in aggressive and non-aggressive forms. Sometimes the subtype of periosteal reaction can suggest a certain process: - Solid periosteal reaction (thin or thick): It is radiographically seen as a focal area of cortical thickening. It is a non-aggressive form associated to benign slow processes (healed fracture, osteoid osteoma and osteomyelitis) Page 16 of 35
17 Fig.: Solid periosteal reaction (osteoid osteoma) Page 17 of 35
18 Fig.: Solid periosteal reaction (osteomyelitis). - Single lamella: It is radiographically seen as a dense line 1-2 mm from the outer surface of the bone. If this space fills with new bone, it will result in a solid periosteal reaction. Suggests slow-growing lesion. - Laminated periosteal reaction (onionskin) consists in multiple layers of new bone. It is seen in a variety of lesions (osteomyelitis, sarcomas, chondroblastomas ) - Spiculated periosteal reaction: It is an aggressive form that appears when linear spicules of new bone form along newly form vascular chanels and fibrous bands. It includes: Page 18 of 35
19 - perpendicular/hair-on-end subtype, in which spicules of bone form perpendicular to the periosteal surface. It is highly suggestive of Ewing s sarcoma. It may coexist with a lamellated pattern - sunburst pattern, with spicules radiating in a divergent pattern. It is often associated with conventional osteosarcomas. Fig.: Aggressive periosteal reaction (prostate cancer metastases). Page 19 of 35
20 Fig.: Aggressive periosteal reaction (lung cancer metastases) - Codman triangle: It is an aggressive form that develops when a portion of periosteum is lifted off the cortex by a mass at the leading point. It is commonly seen in osteosarcomas and occasionally with infection, metastases or hemangiomas. Page 20 of 35
21 Fig.: Codman triangle in osteosarcoma. Considering the unilaterality or bilaterality of the periosteal reaction may be helpful in guiding the diagnosis: - If unilateral it is more likely to be caused by a localized process (trauma, infection or tumor). - If bilateral, one has to consider systemic processes (arthritis, metabolic, congenital, genetic, drug-related and vascular entities). In this setting, the age of presentation of the periosteal reaction can often narrow the diagnosis: Page 21 of 35
22 - < 6 months: physiologic periostitis of the newborn, Caffey disease (also known as infantile cortical hyperostosis) and periostitis related to prostaglandine use. - > 6 months: hypertrophic osteoarthropathy, juvenile idiopathic arthritis, hypervitaminosis A and venous stasis. (In the appropiate clinical setting, it is essential to consider nonaccidental trauma as the underlying cause of multiple healing fractures). c. Mineralization of tumor matrix: Recognition of several types of matrix mineralization is helpful in distinguishing different histologic types of primary bone tumors. The term matrix refers to the type of tissue of the tumor (osteoid, chondral, fibrous or adipose), all of which are radiolucent, and mineralization refers to calcification of the matrix. The pattern of mineralization can be a clue to the type of underlying matrix. Page 22 of 35
23 Fig.: Types of tumor matrix. - Osteoid matrix shows an opaque radiographic appearance: mature ossification typically shows greatest density peripherally, but inmature ossification may be difficult to distinguish from calcification because its appearance is like an ill-defined, homogeneus, cloud-like increased density. A bone-forming tumor is frequently indistinguishable from the bone apposition secondary to bone destruction in the setting of a fracture or reactive sclerosis, but the identification of irregular osteoid incompletely mineralized matrix within or adjacent to a bone destruction region is highly suggestive of osteosarcoma. In the same way, cloudlike densities within medular cavity represent tumoral bone. Page 23 of 35
24 - Chondroid matrix shows punctate, flocculent, arclike or ringlike calcifications. Malignant transformation within a chondral lesion may produce focal destruction of the chondral calcifications. Fig.: Chondral mineralization. It can be difficult to distinguish between osteoid and chondroid matrix: the first one usually shows an amorphous appearance and the second one presents in a organized fashion (trabeculated). - Fibrous matrix shows ground-glass density. Punctate calcification may also be present. Page 24 of 35
25 Fig.: Fibrous matrix tumor Faint mineralization in a lession is best assesed using CT, which is mores sensitive than radiographs for differences in attenuation. d. Size The likelihood of malignancy increases with the size of bony lesions. For example, a 1-2 cm chondral lesion in a long bone is most likely to be an enchondroma, while the risk of being a low-grade chondrosarcoma increases if it is greater than 4 or 5 cm. Page 25 of 35
26 The size of a lesion can also be a clue to its diagnosis. For example, the nidus of the osteoid osteoma is less than 1,5 cm in diameter, while the osteoblastoma is larger than 1,5 cm. e. Cortical response: The cortex may be affected by processes that originate in the medullary canal, periosteum, surrounding soft tissue or within the cortex. As a medullary lesion expands, it may cause erosion of the inner surface of the cortex, called endosteal scalloping. It commonly suggests a chondral or fibrous tumor. Fig.: Cortical response (I). Page 26 of 35
27 Fig.: Cortical response (IV). If the medullary lesion is so aggressive that it erodes the inner aspect of the cortex without giving the periosteum time to lay down new bone, the cortex will eventually be destroyed. The most aggressive malignant lesions can penetrate the cortex before cortical destruction is radiographically visible, so apparent preservation of the cortex does not preclude its involvement. Page 27 of 35
28 Fig.: Cortical response (III). On the other hand, cortical expansion implies that endosteal bone removal due to the lesion is occurring at a similar speed to periosteal bone production. Depending on the aggressiveness of the lesion, the ballooned cortex may have normal thickness or be thin. Page 28 of 35
29 Fig.: Cortical response (II). A process that arises either in the periosteum or adjacent soft tissue may erode the outer surface of the cortex. This feature called saucerization or scalloping of the bone s outer surface can reveal the presence of a soft tissue extraosseus mass otherwise not visible. f. Soft tissue component: The presence of soft tissue mass with a bone lesion suggests a malignant process. Exceptions are giant cell tumor, aneurysmal bone cyst, desmoplastic fibroma and eosinophilic granuloma. Page 29 of 35
30 Inflamatory processes may also show soft tissue mass or swelling, but in these cases the mass is not well-defined and fat planes are affected. Fig.: Soft tissue mass (giant cell tumor). Page 30 of 35
31 Fig.: Soft tissue mass (bone metastases secondary to breast cancer). However, the first question should be: is it a bone tumor with extension to soft tissue planes or is it a soft tissue mass that invades the adjacent bone? Some features may help to answer this question: - the size of the bone lesion: if it is a small bone lesion with large soft tissue component associate, it is more likely to be a primary soft tissue tumor. Ewing s sarcoma may be an exception, because it may show a large peritumoral mass. - the presence of periosteal reaction: it is usually associated to bone tumors. - the location of the epicenter of the lesion within the bone. Page 31 of 35
32 To finish, we well summarize the advantages of CT on the field of focal bone lesions: CT remains superior to plain radiography in demonstrating tumor matrix mineralization. - In osteoid osteoma, CT is more sensitive than MR imaging in detecting the nidus, periosteal reaction and cortical thickening. - In osteomyelitis, sequestra and air within regions affected are more readly identificable by CT. - CT is also highly sensitive in the detection of fluid-fluid levels, which are seen most commonly in aneurysmal bone cyst and also in various rarer lesions, including telangiectatic osteosarcoma. - CT aids in the detection of calcium and fat in a soft tissue mass, which are characteristic in certain tumors, such us synovial chondromatosis, myositis ossificans and welldifferenciated liposarcoma. CT serves as guidance for biopsy and, in some cases, for treatment. For example, radio frequency (RF) and treatment of osteoid osteoma. Page 32 of 35
33 Conclusion The radiologist is essential in the diagnosis of a focal lesion in bone. Plain film is still the starting point in the evaluation of these lesions but new techniques add useful information for the management of these patients. By paying attention to the age of the patient and the location and radiological features of the lesion, the radiologist will lead to a short differential diagnosis list, if not to the correct one. A team work among radiologists, surgeons and pathologists is mandatory for correct diagnosis and proper management and follow-up of the patient. Page 33 of 35
34 Personal Information Page 34 of 35
35 References The Evolution of Musculoskeletal Tumor Imaging. Sinchun Hwang, David M. Panicek. Radiol Clin N Am 47 (2009) Periosteal Reaction. Rana, Wu and Eisenberg. AJR 2009; 193: Evaluation of focal bone lesions: basic principles and clinical scenarios. P O Donnell. Imaging 15 (2003), Bone Tumors and Tumorlike Conditions: Analysis with Conventional Radiography. Miller, T. Radiology 2008; Vol 245: Number 3. Malignant and Benign Bone Tumors. Miller, S and Hoffer, F. Radiol Clin North Am 2001; Vol 39: Num 4. Differential Diagnosis of Tumors and Tumors-like lesions of Bones and Joints. Adam Greenspan, Wolfgang Remagen. CT-guided needle biopsies of bone and soft tissue tumors a pathologist's perspective. Mc Carthy, E. Skeletal Radiol 2007; 36: Page 35 of 35
Cierny-Mader classification of chronic osteomyelitis: Preoperative evaluation with cross-sectional imaging
Cierny-Mader classification of chronic osteomyelitis: Preoperative evaluation with cross-sectional imaging Poster No.: C-590 Congress: ECR 2009 Type: Topic: Educational Exhibit Musculoskeletal Authors:
More informationBone Tumors Clues and Cues
William Herring, M.D. 2002 Bone Tumors Clues and Cues In Slide Show mode, advance the slides by pressing the spacebar All Photos Retain the Copyright of their Authors Clues by Appearance of Lesion Patterns
More informationLong bones manifestations of congenital syphilis
Long bones manifestations of congenital syphilis Poster No.: C-0139 Congress: ECR 2011 Type: Educational Exhibit Authors: T. F. de Souza 1, P. P. Collier 1, E. J. M. Bronzatto 1, G. L. P. Keywords: DOI:
More informationImaging Findings Of Bone Tumors: A Pictorial Review
Imaging Findings Of Bone Tumors: A Pictorial Review Poster No.: C-2511 Congress: ECR 2015 Type: Educational Exhibit Authors: M. Limeme, N. Benzina, A. BelKhiria, H. Zaghouani, S. Majdoub, N. Mallat, H.
More informationTypical skeletal location and differential diagnosis of bone tumors.
Typical skeletal location and differential diagnosis of bone tumors. Poster No.: C-2418 Congress: ECR 2015 Type: Educational Exhibit Authors: M. Barros, L. A. Ferreira, Y. Costa, P. J. V. Coelho, F. Caseiro
More informationFluid-fluid levels in bone tumors: A pictorial review
Fluid-fluid levels in bone tumors: A pictorial review Poster No.: C-578 Congress: ECR 2009 Type: Educational Exhibit Topic: Musculoskeletal Authors: L. Figueroa Nasra, C. Martín Hervás, M. Tapia-Viñé,
More informationThe Radiology Assistant : Bone tumor - ill defined osteolytic tumors and tumor-like lesions
Bone tumor - ill defined osteolytic tumors and tumor-like lesions Henk Jan van der Woude and Robin Smithuis Radiology department of the Onze Lieve Vrouwe Gasthuis, Amsterdam and the Rijnland hospital,
More informationSynovial hemangioma of the suprapatellar bursa
Synovial hemangioma of the suprapatellar bursa Poster No.: P-0040 Congress: ESSR 2013 Type: Authors: Keywords: DOI: Scientific Exhibit A. YESILDAG, S. Keskin, H. Kalkan, S. Kucuksen, U. Kerimoglu; Konya/TR
More informationSeemingly isolated greater trochanter fractures do not exist
Seemingly isolated greater trochanter fractures do not exist Poster No.: B-0950 Congress: ECR 2012 Type: Scientific Paper Authors: D. Dunker, J. H. Göthlin, M. Geijer ; Gothenburg/SE, Lund/SE Keywords:
More informationAPMA 2018 Radiology Track Bone Tumors When to say Gulp!
APMA 2018 Radiology Track Bone Tumors When to say Gulp! DANIEL P. EVANS, DPM, FACFAOM Professor, Department of Podiatric Medicine and Radiology Dr. Wm. Scholl College of Podiatric Medicine Conflict of
More informationSlowly growing malignant nodules and rapidly growing benign nodules: Evaluation of the value of volume doubling time
Slowly growing malignant nodules and rapidly growing benign nodules: Evaluation of the value of volume doubling time Poster No.: C-208 Congress: ECR 2009 Type: Educational Exhibit Topic: Chest Authors:
More informationMalignant Bone Tumors - Part I: a brief revision of diagnostic aspects with conventional radiology
Malignant Bone Tumors - Part I: a brief revision of diagnostic aspects with conventional radiology Poster No.: C-2473 Congress: ECR 2013 Type: Educational Exhibit Authors: I. Candelaria, L. B. Barbosa,
More informationSmall lesions involving scalp and skull in pediatric age.
Small lesions involving scalp and skull in pediatric age. Poster No.: C-1149 Congress: ECR 2013 Type: Educational Exhibit Authors: M. J. Yi, J. H. Yoo; Seoul/KR Keywords: Education and training, Education,
More informationSmall lesions involving scalp and skull in pediatric age.
Small lesions involving scalp and skull in pediatric age. Poster No.: C-1149 Congress: ECR 2013 Type: Educational Exhibit Authors: M. J. Yi, J. H. Yoo; Seoul/ Keywords: Education and training, Education,
More informationCT evaluation of small bowel carcinoid tumors
CT evaluation of small bowel carcinoid tumors Poster No.: C-0060 Congress: ECR 2015 Type: Educational Exhibit Authors: N. V. V. P. Costa, L. Nascimento, T. Bilhim ; Estoril/PT, PT, 1 2 3 1 2 3 Lisbon/PT
More informationPurpose. Methods and Materials. Results
Prevalence and significance of hypoattenuating hepatic lesions deemed too small to characterise: How are we following up these lesions and what are the outcomes? Poster No.: C-014 Congress: ECR 2009 Type:
More informationExcavated pulmonary nodule: steps to diagnosis?
Excavated pulmonary nodule: steps to diagnosis? Poster No.: C-1044 Congress: ECR 2014 Type: Authors: Keywords: DOI: Educational Exhibit W. Mnari, M. MAATOUK, A. Zrig, B. Hmida, M. GOLLI; Monastir/ TN Metastases,
More informationOsteonecrosis - Spectrum of imaging findings
Osteonecrosis - Spectrum of imaging findings Poster No.: C-1861 Congress: ECR 2016 Type: Educational Exhibit Authors: P. Ninitas, A. L. Amado Costa, A. Duarte, I. Távora ; Lisbon/ 1 1 2 1 1 2 PT, Costa
More informationCOPYRIGHT 2004 BY THE JOURNAL OF BONE AND JOINT SURGERY, INCORPORATED
84 COPYRIGHT 2004 BY THE JOURNAL BONE AND JOINT SURGERY, INCORPORATED Radiographic Evaluation of Pathological Bone Lesions: Current Spectrum of Disease and Approach to Diagnosis BY BENJAMIN G. DOMB, MD,
More informationChronic knee pain in adults - a multimodality approach or which modality to choose and when?
Chronic knee pain in adults - a multimodality approach or which modality to choose and when? Poster No.: P-0157 Congress: ESSR 2013 Type: Authors: Keywords: DOI: Scientific Exhibit E. Ilieva, V. Tasseva,
More informationBreast asymmetries in mammography: Management
Breast asymmetries in mammography: Management Poster No.: C-1026 Congress: ECR 2015 Type: Educational Exhibit Authors: V. de Lara Bendahan 1, F. J. Hidalgo Ramos 2, J. L. Ortega Garcia 3, Keywords: DOI:
More informationSoft tissues lymphoma, the great pretender. MRI diagnostic keys.
Soft tissues lymphoma, the great pretender. MRI diagnostic keys. Poster No.: C-2133 Congress: ECR 2015 Type: Educational Exhibit Authors: L. Caminero, M. E. Banegas Illescas, M. L. Rozas, M. Y. Torres,
More informationBI-RADS 3 category, a pain in the neck for the radiologist which technique detects more cases?
BI-RADS 3 category, a pain in the neck for the radiologist which technique detects more cases? Poster No.: B-0966 Congress: ECR 2013 Type: Scientific Paper Authors: J. Etxano Cantera, I. Simon-Yarza, G.
More informationComputed tomography for the detection of thumb base osteoarthritis, comparison with digital radiography.
Computed tomography for the detection of thumb base osteoarthritis, comparison with digital radiography. Poster No.: C-1981 Congress: ECR 2012 Type: Scientific Exhibit Authors: M. S. Saltzherr, J. W. van
More informationExtrapulmonary Manifestations of Tuberculosis: A Radiologic Review
Extrapulmonary Manifestations of Tuberculosis: A Radiologic Review Poster No.: C-1958 Congress: ECR 2014 Type: Authors: Educational Exhibit J. Isern 1, S. Llaverias Borrell 1, A. Olarte 1, E. Grive 1,
More informationComputed tomography and Modified RECIST criteria for assessment of response in malignant pleural mesothelioma
Computed tomography and Modified RECIST criteria for assessment of response in malignant pleural mesothelioma Poster No.: C-0729 Congress: ECR 2013 Type: Scientific Exhibit Authors: A. Marin, I. Pozek,
More informationHyperechoic breast lesions can be malignant.
Hyperechoic breast lesions can be malignant. Poster No.: C-0041 Congress: ECR 2015 Type: Educational Exhibit Authors: G. Babu, R. bradley; Edinburgh/UK Keywords: Breast, Ultrasound, Biopsy, Cancer DOI:
More informationIntracystic papillary carcinoma of the breast
Intracystic papillary carcinoma of the breast Poster No.: C-1932 Congress: ECR 2011 Type: Educational Exhibit Authors: V. Dimarelos, F. TZIKOS, N. Kotziamani, G. Rodokalakis, 1 2 3 1 1 1 2 T. MALKOTSI
More informationEvaluation of BI-RADS 3 lesions in women with a high risk of hereditary breast cancer.
Evaluation of BI-RADS 3 lesions in women with a high risk of hereditary breast cancer. Poster No.: C-0346 Congress: ECR 2014 Type: Scientific Exhibit Authors: A. Thomas 1, R. Dominguez Oronoz 1, S. Roche
More informationThe Radiology Assistant : Bone tumor - well-defined osteolytic tumors and tumor-like lesions
Bone tumor - well-defined osteolytic tumors and tumor-like lesions Henk Jan van der Woude and Robin Smithuis Radiology department of the Onze Lieve Vrouwe Gasthuis, Amsterdam and the Rijnland hospital,
More informationPopliteal pterygium syndrome
Popliteal pterygium syndrome Poster No.: C-1816 Congress: ECR 2011 Type: Educational Exhibit Authors: L. B. S. Santos, J. L. D. O. Schiavon, O. O. Guimaraes Neto, 1 1 2 3 1 1 C. A. P. Braga, R. S. LEMOS,
More informationReview Course «Musculoskeletal Oncology» October 6, 2011 UNIKLINIK BALGRIST. Imaging of Bone and Soft Tissue. Tumors
Imaging of Bone and Soft Tissue Tumors Approach from a radiologist s point of view Florian Buck Radiology Radio- Radio- Oncologist Oncologist Orthopedist Orthopedist Patient Management Oncologist Oncologist
More informationPurpose. Methods and Materials
Thin-section CT findings in peripheral lung cancer of 3 cm or smaller: are there any characteristic features for predicting tumor histology or do they depend only on tumor size? Poster No.: C-1893 Congress:
More informationMRI in Patients with Forefoot Pain Involving the Metatarsal Region
MRI in Patients with Forefoot Pain Involving the Metatarsal Region Poster No.: C-0151 Congress: ECR 2015 Type: Authors: Keywords: DOI: Scientific Exhibit R. Vukojevi#, M. Mustapic, D. Marjan; Zagreb/HR
More informationImaging characterization of renal clear cell carcinoma
Imaging characterization of renal clear cell carcinoma Poster No.: C-0327 Congress: ECR 2011 Type: Educational Exhibit Authors: S. Ballester 1, A. Gaser 2, M. Dotta 1, M. F. CAPPA 1, F. Hammar 1 ; 1 2
More informationDiffuse Alveolar Hemorrhage: Initial and Follow-up HRCT Features
Diffuse Alveolar Hemorrhage: Initial and Follow-up HRCT Features Poster No.: E-0037 Congress: ESTI 2012 Type: Authors: Keywords: Scientific Exhibit M. Y. Kim; Seoul/KR Lung, CT-High Resolution, CT, Computer
More informationMR imaging findings of extranodal-skeletal muscle lymphoma
R imaging findings of extranodal-skeletal muscle lymphoma Poster No.: C-0261 Congress: ECR 2013 Type: Scientific Exhibit Authors: C. A. Kadioglu, S. Keskin,. A. Yinanc, O. Ertunç; Ankara/TR Keywords: usculoskeletal
More informationDiffuse high-attenuation within mediastinal lymph nodes on non-enhanced CT scan: Usefulness in the prediction of benignancy
Diffuse high-attenuation within mediastinal lymph nodes on non-enhanced CT scan: Usefulness in the prediction of benignancy Poster No.: C-1785 Congress: ECR 2012 Type: Authors: Keywords: DOI: Scientific
More informationSingle cold nodule in Graves' disease: benign vs malignant
Single cold nodule in Graves' disease: benign vs malignant Poster No.: C-0073 Congress: ECR 2011 Type: Authors: Keywords: DOI: Scientific Paper L. I. Sonoda, M. Halim, K. Balan; Cambridge/UK Head and neck,
More information64-MDCT imaging of the pancreas: Scan protocol optimisation by different scan delay regimes
64-MDCT imaging of the pancreas: Scan protocol optimisation by different scan delay regimes Poster No.: C-051 Congress: ECR 2009 Type: Scientific Exhibit Topic: Abdominal and Gastrointestinal Authors:
More informationRadiologic and pathologic correlation of non-mass like breast lesions on US and MRI: Benign, high risk, versus malignant
Radiologic and pathologic correlation of non-mass like breast lesions on US and MRI: Benign, high risk, versus malignant Poster No.: C-1161 Congress: ECR 2013 Type: Educational Exhibit Authors: J. Kwak,
More informationRadiologic and pathologic correlation of non-mass like breast lesions on US and MRI: Benign, high risk, versus malignant
Radiologic and pathologic correlation of non-mass like breast lesions on US and MRI: Benign, high risk, versus malignant Poster No.: C-1161 Congress: ECR 2013 Type: Educational Exhibit Authors: J. Kwak,
More informationA pictorial review of normal anatomical appearences of Pericardial recesses on multislice Computed Tomography.
A pictorial review of normal anatomical appearences of Pericardial recesses on multislice Computed Tomography. Poster No.: C-1787 Congress: ECR 2012 Type: Educational Exhibit Authors: N. Ahmed 1, G. Avery
More informationRadiological features of Legionella Pneumophila Pneumonia
Radiological features of Legionella Pneumophila Pneumonia Poster No.: E-0048 Congress: ESTI 2012 Type: Scientific Exhibit Authors: M. Vinciguerra, L. Stefanetti, E. Teti, G. Argentieri, L. G. 1 1 1 1 1
More informationReliability of the pronator quadratus fat pad sign to predict the severity of distal radius fractures
Reliability of the pronator quadratus fat pad sign to predict the severity of distal radius fractures Poster No.: C-0669 Congress: ECR 2014 Type: Scientific Exhibit Authors: J. Tonak, I. Wobbe, R. L. Duschka,
More informationUnusual location of bone sarcoma in children
Unusual location of bone sarcoma in children Poster No.: C-1517 Congress: ECR 2014 Type: Educational Exhibit Authors: S. JERBI, A. Khalfalli, G. Abid, O. Bradai, N. chouchane, H. HAMZA; Mahdia/TN Keywords:
More informationTriple-negative breast cancer: which typical features can we identify on conventional and MRI imaging?
Triple-negative breast cancer: which typical features can we identify on conventional and MRI imaging? Poster No.: C-1862 Congress: ECR 2013 Type: Educational Exhibit Authors: V. Bertani 1, A. Gualano
More informationMR imaging of FIGO stage I uterine cervical cancer: The diagnostic impact of 3T-MRI
MR imaging of FIGO stage I uterine cervical cancer: The diagnostic impact of 3T-MRI Poster No.: C-1191 Congress: ECR 2010 Type: Educational Exhibit Topic: Genitourinary Authors: M. Takeuchi, K. Matsuzaki,
More informationUltrasound assessment of most frequent shoulder disorders
Ultrasound assessment of most frequent shoulder disorders Poster No.: C-2026 Congress: ECR 2014 Type: Educational Exhibit Authors: S. P. Ivanoski; Ohrid/MK Keywords: Trauma, Athletic injuries, Arthritides,
More informationARDS - a must know. Page 1 of 14
ARDS - a must know Poster No.: C-1683 Congress: ECR 2016 Type: Authors: Keywords: DOI: Educational Exhibit M. Cristian; Turda/RO Education and training, Edema, Acute, Localisation, Education, Digital radiography,
More informationFiguring out the "fronds"-synovial proliferative disorders of the knee.
Figuring out the "fronds"-synovial proliferative disorders of the knee. Poster No.: C-1209 Congress: ECR 2014 Type: Educational Exhibit Authors: S. Sivasubramanian; Tamil Nadu/IN Keywords: Imaging sequences,
More informationCT Fluoroscopy-Guided vs Multislice CT Biopsy ModeGuided Lung Biopies:a preliminary experience
CT Fluoroscopy-Guided vs Multislice CT Biopsy ModeGuided Lung Biopies:a preliminary experience Poster No.: C-0097 Congress: ECR 2016 Type: Scientific Exhibit Authors: A. Casarin, G. Rech, C. Cicero, A.
More informationCognitive target MRI-TRUS fusion biopsies of MRI detected PIRADS 4 and 5 lesions
Cognitive target MRI-TRUS fusion biopsies of MRI detected PIRADS 4 and 5 lesions Poster No.: B-0704 Congress: ECR 2015 Type: Scientific Paper Authors: P. P. van Westerveld, J. Vriesema, J. H. W. van den
More informationA Pictorial Review of Congenital Tarsal Coalition
A Pictorial Review of Congenital Tarsal Coalition Poster No.: C-2305 Congress: ECR 2011 Type: Educational Exhibit Authors: J. Jethwa, M. Tapp; Torquay/UK Keywords: Musculoskeletal joint, Musculoskeletal
More informationDifferentiation of osteoporosis from metastasis in the vertebral fracture using chemical shift and diffusion weighted imaging
Differentiation of osteoporosis from metastasis in the vertebral fracture using chemical shift and diffusion weighted imaging Poster No.: C-0444 Congress: ECR 2012 Type: Educational Exhibit Authors: H.
More informationMRI in staging of rectal carcinoma
MRI in staging of rectal carcinoma Poster No.: C-0152 Congress: ECR 2015 Type: Scientific Exhibit Authors: J. R. Ramos Rodriguez, M. Atencia Ballesteros, M. D. M. Muñoz Ruiz, A. J. Márquez Moreno, M. D.
More informationLow-dose computed tomography (CT) protocol in the screening of patients with social exposure to asbestos
Low-dose computed tomography (CT) protocol in the screening of patients with social exposure to asbestos Poster No.: C-3032 Congress: ECR 2010 Type: Scientific Exhibit Topic: Radiographers Authors: P.
More informationThe "whirl sign". Diagnostic accuracy for intestinal volvulus.
The "whirl sign". Diagnostic accuracy for intestinal volvulus. Poster No.: C-0670 Congress: ECR 2014 Type: Scientific Exhibit Authors: M. Pire, M. Marti, A. Borobia, A. Verón; Madrid/ES Keywords: Abdomen,
More informationSonographic and Mammographic Features of Phyllodes Tumours of the Breast: Correlation with Histological Grade
Sonographic and Mammographic Features of Phyllodes Tumours of the Breast: Correlation with Histological Grade Poster No.: C-0046 Congress: ECR 2014 Type: Authors: Keywords: DOI: Scientific Exhibit C. Y.
More informationBreast ultrasound appearances after Mammotome vacuumassisted
Breast ultrasound appearances after Mammotome vacuumassisted biopsy. Poster No.: C-1924 Congress: ECR 2011 Type: Educational Exhibit Authors: R. Patel 1, G. R. Kaplan 2 ; 1 London/UK, 2 Herts/UK Keywords:
More informationValsalva-manoeuvre or prone belly position for computed tomography (CT) scan when an orbita varix is suspected: a single-case study.
Valsalva-manoeuvre or prone belly position for computed tomography (CT) scan when an orbita varix is suspected: a single-case study. Poster No.: C-0512 Congress: ECR 2012 Type: Authors: Keywords: DOI:
More informationSkeletal changes in endocrine disorders
Skeletal changes in endocrine disorders Poster No.: P-0100 Congress: ESSR 2015 Type: Authors: Educational Poster A. C. O'Brien 1, H. L. khosa 2, A. levai 2, N. Ramesh 2 ; 1 Dublin/IE, 2 Portlaoise/IE Keywords:
More informationCavitary lung lesion: Two different diagnosis with similar appearence
Cavitary lung lesion: Two different diagnosis with similar appearence Poster No.: P-0043 Congress: ESTI 2015 Type: Educational Poster Authors: M. Yesildag, H. Kalkan, K. Ödev; Konya/TR Keywords: Infection,
More informationSpectrum of findings of sclerosing adenosis at breast MRI.
Spectrum of findings of sclerosing adenosis at breast MRI. Poster No.: C-0738 Congress: ECR 2012 Type: Scientific Exhibit Authors: F. Vasselli 1, F. Pediconi 2, M. Telesca 2, M. Luciani 2, V. Casali 2,
More informationCharacterisation of cervical lymph nodes by US and PET-CT
Characterisation of cervical lymph nodes by US and PET-CT Poster No.: C-1807 Congress: ECR 2010 Type: Educational Exhibit Topic: Head and Neck Authors: J. I. Garcia Gomez; Mexico City/MX Keywords: cervical
More informationCT findings of osteoradionecrosis of the mandible
CT findings of osteoradionecrosis of the mandible Poster No.: C-2569 Congress: ECR 2015 Type: Educational Exhibit Authors: J. Abreu e Silva, M. J. Magalhães, N. Costa, S. Ramos Alves, M. V. P. P. Gouvea;
More informationAdenomyosis by myometrial Invasion of endometriosis: Comparison with typical adenomyosis
Adenomyosis by myometrial Invasion of endometriosis: Comparison with typical adenomyosis Poster No.: C-1294 Congress: ECR 2010 Type: Scientific Exhibit Topic: Genitourinary Authors: S. Moon, H. K. Lim,
More informationKeratocystic Odontogenic Tumor : What radiologist needs to know?
Keratocystic Odontogenic Tumor : What radiologist needs to know? Poster No.: C-0444 Congress: ECR 2014 Type: Authors: Keywords: DOI: Educational Exhibit K. El Karzazi, J. M. Villanueva Rincón, R. Corrales,
More informationMR imaging features of paralabral ganglion cyst of the shoulder
MR imaging features of paralabral ganglion cyst of the shoulder Poster No.: C-1482 Congress: ECR 2016 Type: Educational Exhibit Authors: M. Bartocci, C. Dell'atti, E. Federici, D. Beomonte Zobel, V. Martinelli,
More informationLesions of the pancreaticoduodenal groove, a pictorial review
Lesions of the pancreaticoduodenal groove, a pictorial review Poster No.: C-2131 Congress: ECR 2013 Type: Educational Exhibit Authors: E. Ni Mhurchu, L. Lavelle, I. Murphy, S. Skehan ; IE, Dublin/ IE Keywords:
More informationBI-RADS 3, 4 and 5 lesions on US: Five categories and their diagnostic efficacy and pitfalls in interpretation
BI-RADS 3, 4 and 5 lesions on US: Five categories and their diagnostic efficacy and pitfalls in interpretation e-poster: C-118 Congress: ECR 2008 Type: Educational Exhibit Topic: Breast / Ultrasound Authors:
More informationUltrasound and radiography findings in developmental dysplasia of the hip: a pictorial review
Ultrasound and radiography findings in developmental dysplasia of the hip: a pictorial review Poster No.: C-2542 Congress: ECR 2012 Type: Educational Exhibit Authors: S. P. Ivanoski; Ohrid/MK Keywords:
More informationKnee ultrasound in pediatric patients - anatomy, diagnostic pitfalls, common pathologies.
Knee ultrasound in pediatric patients - anatomy, diagnostic pitfalls, common pathologies. Poster No.: C-2434 Congress: ECR 2015 Type: Educational Exhibit Authors: C. M. Olchowy, M. Lasecki, M. Inglot,
More informationBreast calcification: Management and Pictorial Review
Breast calcification: Management and Pictorial Review Poster No.: C-0692 Congress: ECR 2014 Type: Educational Exhibit Authors: V. de Lara Bendahan, M. F. Ramos Solis, A. Amador Gil, C. 1 2 3 2 4 4 Gómez
More informationCategorical Classification of Spiculated Mass on Breast MRI
Categorical Classification of Spiculated Mass on Breast MRI Poster No.: C-1974 Congress: ECR 2013 Type: Authors: Scientific Exhibit Y. Kanda 1, S. Kanao 2, M. Kataoka 2, K. Togashi 2 ; 1 Kyoto City/JP,
More informationBone Tumours - a synopsis. Dr Zena Slim SpR in Histopathology QAH 2009
Bone Tumours - a synopsis Dr Zena Slim SpR in Histopathology QAH 2009 Aims General approach to diagnosis Common entities.and not so common ones. Mini quiz Challenge of bone tumour diagnosis Bone tumours
More informationAnatomical Variations of the Levator Scapulae Muscle - an MR Imaging Study
Anatomical Variations of the Levator Scapulae Muscle - an MR Imaging Study Poster No.: R-0016 Congress: 2015 ASM Type: Scientific Exhibit Authors: J. Au, A. Webb, G. Buirski, P. Smith, M. Pickering, D.
More informationHigh density thrombi of pulmonary embolism on precontrast CT scan: Is it dangerous?
High density thrombi of pulmonary embolism on precontrast CT scan: Is it dangerous? Poster No.: C-1753 Congress: ECR 2013 Type: Authors: Keywords: DOI: Scientific Exhibit B. Y. Lee, H. R. KIM, J. I. Jung,
More informationCharacterization of adrenal lesions on CT and MRI: all that a radiologist must know
Characterization of adrenal lesions on CT and MRI: all that a radiologist must know Poster No.: C-2476 Congress: ECR 2013 Type: Educational Exhibit Authors: N. Benzina, S. MAJDOUB, C. H. ZARRAD, H. Zaghouani,
More informationOlecranon lesions: Radiographic Appearances with Cross Sectional Imaging Correlation
Olecranon lesions: Radiographic Appearances with Cross Sectional Imaging Correlation Poster No.: P-0107 Congress: ESSR 2014 Type: Educational Poster Authors: U. Kularatne, N. Evans, S. L. J. James ; Nottingham/UK,
More informationEmerging Referral Patterns for Whole-Body Diffusion Weighted Imaging (WB-DWI) in an Oncology Center
Emerging Referral Patterns for Whole-Body Diffusion Weighted Imaging (WB-DWI) in an Oncology Center Poster No.: C-1296 Congress: ECR 2014 Type: Scientific Exhibit Authors: G. Petralia 1, G. Conte 1, S.
More informationDigital breast tomosynthesis (DBT) occult breast cancers: clinical, radiological and histopathological features.
Digital breast tomosynthesis (DBT) occult breast cancers: clinical, radiological and histopathological features. Poster No.: C-1707 Congress: ECR 2015 Type: Scientific Exhibit Authors: V. Vinci 1, A. Iqbal
More informationCorrelation Between BIRADS Classification and Ultrasound -guided Tru-Cut Biopsy Results of Breast Lesions: Retrospective Analysis of 285 Patients
Correlation Between BIRADS Classification and Ultrasound -guided Tru-Cut Biopsy Results of Breast Lesions: Retrospective Analysis of 285 Patients Poster No.: C-1433 Congress: ECR 2014 Type: Scientific
More informationImaging Gorham's disease (vanishing bone)
Imaging Gorham's disease (vanishing bone) Poster No.: C-2201 Congress: ECR 2010 Type: Scientific Exhibit Topic: Musculoskeletal Authors: D. Vanel, P. Ruggieri, M. Alberghini; Bologna/IT Keywords: Gorham,
More informationAssesment by MRI in the diagnosing of osteomyelitis in children
Assesment by MRI in the diagnosing of osteomyelitis in children Poster No.: C-1295 Congress: ECR 2011 Type: Educational Exhibit Authors: M. Teixidor Viñas, J. L. Ribó, J. muxart, J. Blanch, L. Riaza ;
More informationRetroperitoneal Sarcomas - A pictorial review
Retroperitoneal Sarcomas - A pictorial review Poster No.: C-1409 Congress: ECR 2013 Type: Educational Exhibit Authors: D. Douraghi-Zadeh, K. L. Shahabuddin, R. H. Thomas, E. Moskovic; London/UK Keywords:
More informationScientific Exhibit Authors: V. Moustakas, E. Karallas, K. Koutsopoulos ; Rodos/GR, 2
Diagnosis of Acute Appendicitis: the role of Color Doppler Ultrasound as first-line imaging method and evaluation of the higher diagnostic performances of CT against its disadvantages. Poster No.: C-0708
More informationThe Radiologic Features of Xanthogranulomatous Cholecystitis: An Important Mimic of Gallbladder Carcinoma
The Radiologic Features of Xanthogranulomatous Cholecystitis: An Important Mimic of Gallbladder Carcinoma Poster No.: C-0691 Congress: ECR 2014 Type: Authors: Keywords: DOI: Educational Exhibit H. L. khosa
More informationIdiopathic dilatation of the pulmonary artery : radiographic and MDCT features in 6 cases
Idiopathic dilatation of the pulmonary artery : radiographic and MDCT features in 6 cases Poster No.: P-0075 Congress: ESTI 2014 Type: Authors: Educational Poster J. J. Woo 1, K. Y. Lee 2, Y. Cho 1, J.
More informationIdentification and numbering of lumbar vertebrae using various anatomical landmarks on MRI of lumbosacral spine
Identification and numbering of lumbar vertebrae using various anatomical landmarks on MRI of lumbosacral spine Poster No.: C-2125 Congress: ECR 2015 Type: Authors: Scientific Exhibit S. patil 1, A. M.
More informationFeasibility of magnetic resonance elastography using myofascial phantom model
Feasibility of magnetic resonance elastography using myofascial phantom model Poster No.: C-0971 Congress: ECR 2013 Type: Scientific Exhibit Authors: H. J. Kang, J.-S. Yoon, S.-J. Hong, C.-H. Oh, S. H.
More informationImaging features of orbital neoplasm developed in pediatrics
Imaging features of orbital neoplasm developed in pediatrics Poster No.: C-1119 Congress: ECR 2015 Type: Educational Exhibit Authors: J. H. Yoo; Seoul/KR Keywords: Eyes, Head and neck, Paediatric, CT,
More informationThe solitary pulmonary nodule: Assessing the success of predicting malignancy
The solitary pulmonary nodule: Assessing the success of predicting malignancy Poster No.: C-0829 Congress: ECR 2010 Type: Scientific Exhibit Topic: Chest Authors: R. W. K. Lindsay, J. Foster, K. McManus;
More informationYoung and Old Bone: Early signs of disturbed fracture healing.
Young and Old Bone: Early signs of disturbed fracture healing. Poster No.: C-2502 Congress: ECR 2017 Type: Educational Exhibit Authors: B. V. G. Pinedo, R. García Buen-Abad, R. CHOZA 1 2 3 4 5 6 CHENHALLS,
More informationDynamic CT Assessment of Distal Radioulnar Instability
Dynamic CT Assessment of Distal Radioulnar Instability Poster No.: P-0114 Congress: ESSR 2016 Type: Educational Poster Authors: S. Dumonteil, M. A. Shah, A. Srikanthan, V. Ejindu, N. Papadakos; London/UK
More informationDiffusion-weighted MRI (DWI) "claw sign" is useful in differentiation of infectious from degenerative Modic I signal changes of the spine
Diffusion-weighted MRI (DWI) "claw sign" is useful in differentiation of infectious from degenerative Modic I signal changes of the spine Poster No.: C-0894 Congress: ECR 2012 Type: Scientific Exhibit
More informationComputed tomographic dacryocystography as compared with X-ray dacryocystography in patients with dacryostenosis
Computed tomographic dacryocystography as compared with X-ray dacryocystography in patients with dacryostenosis Poster No.: C-1887 Congress: ECR 2016 Type: Authors: Keywords: DOI: Educational Exhibit M.
More informationCircles are Pointless - Angles in the assessment of adult hip dysplasia are not!
Circles are Pointless - Angles in the assessment of adult hip dysplasia are not! Poster No.: C-1964 Congress: ECR 2014 Type: Authors: Keywords: DOI: Educational Exhibit S. E. West, S. G. Cross, J. Adu,
More informationArticular disease of the hand - the target joint approach
Articular disease of the hand - the target joint approach Poster No.: C-1817 Congress: ECR 2016 Type: Educational Exhibit Authors: R. R. Domingues Madaleno 1, A. P. Pissarra 1, I. Abreu 2, A. Canelas 1,
More informationTHI-RADS. US differentiation of thyroid lesions.
THI-RADS. US differentiation of thyroid lesions. Poster No.: C-0864 Congress: ECR 2015 Type: Scientific Exhibit Authors: A. N. Sencha, Y. Patrunov, M. S. Mogutov, E. Penyaeva, A. 1 1 1 2 1 1 1 2 Gruzdev,
More information