Kemik Tümörlerinde Radyolojik Bulgular
Özet
Kemik tümörleri arasında primer malign olanlar, primer benign tümörlere ve kemik metastazlarına kıyasla oldukça nadir rastlanır. Radyolojik yöntemler, özellikle direk grafiler, kemik tümörlerinin tanısında ve malign-benign ayrımının yapılmasında önemli rol oynar. Ayrıca, bazı primer kemik tümörlerinin özelliklerini belirlemekte de bu yöntemler fayda sağlar. Kemik tümörlerinin radyografik teşhisi için yapılan değerlendirmeler, lezyonun düzenli bir şekilde incelenmesini ve belirli radyografik kriterlere odaklanmayı gerektirir. Bu kriterler, öncelikli olarak geleneksel radyografilerde tanımlanmış olsa da, bilgisayarlı tomografi (BT) görüntüleri üzerinden de değerlendirilebilir. Dikkate alınması gereken önemli radyografik unsurlar arasında; tümör lokalizasyonu, sınır özellikleri ve geçiş zonu, periosteal reaksiyon, mineralizasyon durumu, lezyon boyut ve sayısı ile yumuşak doku bileşenlerinin varlığı yer alır. Radyografik bulgular çoğu zaman tanıda yardımcı olur, ancak kesin teşhis için klinik veriler ve bazı durumlarda histopatolojik incelemeler gereklidir. Klinik değerlendirmede hastanın yaşı önemli bir faktördür; radyolojik incelemelerde ise tutulan kemiğin ve kemiğin hangi bölümünün etkilendiği dikkate alınmalıdır. Bu faktörler, kemik tümörlerinin tanısında ilk aşamada değerlendirilmesi gereken temel unsurlar olup, tanıya ulaşmada önemli ipuçları sunar.
Among bone tumors, primary malignant ones are significantly rarer compared to primary benign tumors and bone metastases. Radiological techniques, particularly plain radiographs, play a crucial role in the diagnosis of bone tumors and in distinguishing between malignant and benign lesions. Additionally, these methods are helpful in characterizing certain primary bone tumors. The radiographic evaluation of bone tumors involves a systematic analysis of the lesion and focusing on specific radiographic criteria. Although these criteria are primarily defined based on conventional radiographs, they can also be applied to computed tomography (CT) scans. Key radiographic features to consider include tumor location, margin characteristics and transition zone, periosteal reactions, degree of mineralization, lesion size and number, as well as the presence of soft tissue components. While radiographic findings often aid in diagnosis, definitive diagnosis requires clinical data and, in some cases, histopathological examinations. In clinical assessment, the patient's age is a critical factor, and in radiological evaluations, the specific bone and the affected region of the bone should be considered. These factors provide essential clues in the initial approach to diagnosing bone tumors and are key elements in reaching an accurate diagnosis.
Referanslar
Miller TT. Bone tumors and tumorlike conditions: analysis with conventional radiography. Radiology. 2008;246(3):662-674. doi:10.1148/radiol.2463061038
Kaya T. Kemik ve yumuşak doku tümörlerinin de¬ğerlendirilmesinde temel radyografik ilkeler. Türk Radyoloji Seminerleri. 2017;5:1-22.
Tokgöz N. Kemik Tümörlerinde Radyolojik Değerlendirme. Türk Radyoloji Seminerleri. 2021;9:1-14.
Priolo F, Cerase A. The current role of radiography in the assessment of skeletal tumors and tumor-like lesions. European Journal of Radiology. 1998;27 Suppl 1:S77-S85. doi:10.1016/s0720-048x(98)00047-3
Madewell JE, Ragsdale BD, Sweet DE. Radiologic and pathologic analysis of solitary bone lesions. Part I: internal margins. Radiologic Clinics of North America. 1981;19(4):715-748.
Brown KT, Kattapuram SV, Rosenthal DI. Computed tomography analysis of bone tumors: patterns of cortical destruction and soft tissue extension. Skeletal Radiology. 1986;15(6):448-451. doi:10.1007/BF00355103
Seeger LL, Dungan DH, Eckardt JJ, et al. Nonspecific findings on MR imaging. The importance of correlative studies and clinical information. Clinical Orthopaedics and Related Research. 1991;(270):306-312.
Hayes CW, Conway WF, Sundaram M. Misleading aggressive MR imaging appearance of some benign musculoskeletal lesions. Radiographics. 1992;12(6):1119-1136. doi:10.1148/radiographics.12.6.1439015
Ma LD, Frassica FJ, Scott WW Jr, et al. Differentiation of benign and malignant musculoskeletal tumors: potential pitfalls with MR imaging. Radiographics. 1995;15(2):349-366. doi:10.1148/radiographics.15.2.7761640
Berquist TH, Dalinka MK, Alazraki N, et al. Bone tumors. American College of Radiology. ACR Appropriateness Criteria. Radiology. 2000;215 Suppl:261-264.
Costelloe CM, Rohren EM, Madewell JE, et al. Imaging bone metastases in breast cancer: techniques and recommendations for diagnosis. Lancet Oncology. 2009;10(6):606-614. doi:10.1016/S1470-2045(09)70088-9
Costelloe CM, Madewell JE. Radiography in the initial diagnosis of primary bone tumors. AJR Am J Roentgenol. 2013;200(1):3-7. doi:10.2214/AJR.12.8488
Berquist TH, MRI of the musculoskeletal system, 4th. Ed. Philadelphia: Lippincott Williams & Wilkins; 2001.
Clifford PD, Temple HT, Bone and soft tissue tumors in; Edelman RR, Hesselink JR, Zlatkin MB, Crues JV. Clinical Magnetic Resonance Imaging, third ed, vol 3, body, musculoskeletal system, Saunders Elsevier, 2006.
Kaya T. Kemik ve yumuşak doku tümörlerinde radyolojik özellikler in: Dabak N. Multidisipliner Yaklaşımla Kemik ve Yumuşak Doku Tümörleri, TOTBİD yayınları Ankara, 2013.
Lang P, Johnston JO, Arenal-Romero F, et al. Advances in MR imaging of pediatric musculoskeletal neoplasms. Magnetic Resonance Imaging Clinics of North America. 1998;6(3):579-604.
Mavrogenis AF, Angelini A, Errani C, et al. How should musculoskeletal biopsies be performed?. Orthopedics. 2014;37(9):585-588. doi:10.3928/01477447-20140825-03
Traina F, Errani C, Toscano A, et al. Current concepts in the biopsy of musculoskeletal tumors: AAOS exhibit selection. The Journal of Bone and Joint Surgery. 2015;97(2):e7. doi:10.2106/JBJS.N.00661
Fayad LM, Jacobs MA, Wang X, et al. Musculoskeletal tumors: how to use anatomic, functional, and metabolic MR techniques. Radiology. 2012;265(2):340-356. doi:10.1148/radiol.12111740
Umer M, Hasan OHA, Khan D, et al. Systematic approach to musculoskeletal benign tumors. International Journal of Surgery Oncology. 2017;2(11):e46. doi:10.1097/IJ9.0000000000000046
Resnick D. Diagnosis of bone and joint disorders. 4th ed. Tumors and tumor-like diseases. Philadelphia: PA, Saunders, 2004.
Resnick, D, Kransdorf MJ. Bone and joint imaging. 3rd ed. Philadelphia: Elsevier; 2005.
Mehta K, McBee MP, Mihal DC, et al. Radiographic Analysis of Bone Tumors: A Systematic Approach. Seminars in Roentgenology. 2017;52(4):194-208. doi:10.1053/j.ro.2017.04.002
Helms CA. Osteoid osteoma. The double density sign. Clinical Orthopaedics and Related Research. 1987;(222):167-173.
Kaya T. Kas iskelet - yumuşak doku radyolojisi. Nobel & Güneş Kitabevi, Bursa, 2008.
Brant W, Helms CA. Fundamentals of diagnostic radiology (3rd ed). Musculoskeletal radiology section. Philadelphia: PA, Lippincott; 2007.
Rowe LJ, Yochum TR. Essentials of Skeletal Radi¬ology. 3rd ed. Philadelphia: Lippincott Williams & Wilkins; 2005.
Errani C, Tsukamoto S, Mavrogenis AF. Imaging Analyses of Bone Tumors. JBJS Reviews. 2020;8(3):e0077. doi:10.2106/JBJS.RVW.19.00077
Unni KK, Inwards CY. Dahlin’s bone tumors. 6th edition. Philadelphia: Lippincott; 2010.
White LM, Kandel R. Osteoid-producing tumors of bone. Seminars in Musculoskeleteal Radiology. 2000;4(1):25-43. doi:10.1055/s-2000-6853
Kendell SD, Collins MS, Adkins MC, et al. Radiographic differentiation of enchondroma from low-grade chondrosarcoma in the fibula. Skeletal Radiology. 2004;33(8):458-466. doi:10.1007/s00256-004-0791-9
Levine SM, Lambiase RE, Petchprapa CN. Cortical lesions of the tibia: characteristic appearances at conventional radiography. Radiographics. 2003;23(1):157-177. doi:10.1148/rg.231015088
Murphey MD, Robbin MR, McRae GA, et al. The many faces of osteosarcoma. Radiographics.1997;17(5):1205-1231. doi:10.1148/radiographics.17.5.9308111
Mulligan ME. Myeloma and lymphoma. Seminars in Musculoskelet Radiology. 2000;4(1):127-135. doi:10.1055/s-2000-6860
Touraine S, Emerich L, Bisseret D, et al. Is pain duration associated with morphologic changes of osteoid osteomas at CT?. Radiology. 2014;271(3):795-804. doi:10.1148/radiol.14131629
Liu PT, Chivers FS, Roberts CC, et al. Imaging of osteoid osteoma with dynamic gadolinium-enhanced MR imaging. Radiology. 2003;227(3):691-700. doi:10.1148/radiol.2273020111
James SL, Panicek DM, Davies AM. Bone marrow oedema associated with benign and malignant bone tumours. European Journal of Radiology. 2008;67(1):11-21. doi:10.1016/j.ejrad.2008.01.052
Gronemeyer SA, Kauffman WM, Rocha MS, et al. Fat-saturated contrast-enhanced T1-weighted MRI in evaluation of osteosarcoma and Ewing sarcoma. Journal of Magnetic Resonance Imaging. 1997;7(3):585-589. doi:10.1002/jmri.1880070321
Referanslar
Miller TT. Bone tumors and tumorlike conditions: analysis with conventional radiography. Radiology. 2008;246(3):662-674. doi:10.1148/radiol.2463061038
Kaya T. Kemik ve yumuşak doku tümörlerinin de¬ğerlendirilmesinde temel radyografik ilkeler. Türk Radyoloji Seminerleri. 2017;5:1-22.
Tokgöz N. Kemik Tümörlerinde Radyolojik Değerlendirme. Türk Radyoloji Seminerleri. 2021;9:1-14.
Priolo F, Cerase A. The current role of radiography in the assessment of skeletal tumors and tumor-like lesions. European Journal of Radiology. 1998;27 Suppl 1:S77-S85. doi:10.1016/s0720-048x(98)00047-3
Madewell JE, Ragsdale BD, Sweet DE. Radiologic and pathologic analysis of solitary bone lesions. Part I: internal margins. Radiologic Clinics of North America. 1981;19(4):715-748.
Brown KT, Kattapuram SV, Rosenthal DI. Computed tomography analysis of bone tumors: patterns of cortical destruction and soft tissue extension. Skeletal Radiology. 1986;15(6):448-451. doi:10.1007/BF00355103
Seeger LL, Dungan DH, Eckardt JJ, et al. Nonspecific findings on MR imaging. The importance of correlative studies and clinical information. Clinical Orthopaedics and Related Research. 1991;(270):306-312.
Hayes CW, Conway WF, Sundaram M. Misleading aggressive MR imaging appearance of some benign musculoskeletal lesions. Radiographics. 1992;12(6):1119-1136. doi:10.1148/radiographics.12.6.1439015
Ma LD, Frassica FJ, Scott WW Jr, et al. Differentiation of benign and malignant musculoskeletal tumors: potential pitfalls with MR imaging. Radiographics. 1995;15(2):349-366. doi:10.1148/radiographics.15.2.7761640
Berquist TH, Dalinka MK, Alazraki N, et al. Bone tumors. American College of Radiology. ACR Appropriateness Criteria. Radiology. 2000;215 Suppl:261-264.
Costelloe CM, Rohren EM, Madewell JE, et al. Imaging bone metastases in breast cancer: techniques and recommendations for diagnosis. Lancet Oncology. 2009;10(6):606-614. doi:10.1016/S1470-2045(09)70088-9
Costelloe CM, Madewell JE. Radiography in the initial diagnosis of primary bone tumors. AJR Am J Roentgenol. 2013;200(1):3-7. doi:10.2214/AJR.12.8488
Berquist TH, MRI of the musculoskeletal system, 4th. Ed. Philadelphia: Lippincott Williams & Wilkins; 2001.
Clifford PD, Temple HT, Bone and soft tissue tumors in; Edelman RR, Hesselink JR, Zlatkin MB, Crues JV. Clinical Magnetic Resonance Imaging, third ed, vol 3, body, musculoskeletal system, Saunders Elsevier, 2006.
Kaya T. Kemik ve yumuşak doku tümörlerinde radyolojik özellikler in: Dabak N. Multidisipliner Yaklaşımla Kemik ve Yumuşak Doku Tümörleri, TOTBİD yayınları Ankara, 2013.
Lang P, Johnston JO, Arenal-Romero F, et al. Advances in MR imaging of pediatric musculoskeletal neoplasms. Magnetic Resonance Imaging Clinics of North America. 1998;6(3):579-604.
Mavrogenis AF, Angelini A, Errani C, et al. How should musculoskeletal biopsies be performed?. Orthopedics. 2014;37(9):585-588. doi:10.3928/01477447-20140825-03
Traina F, Errani C, Toscano A, et al. Current concepts in the biopsy of musculoskeletal tumors: AAOS exhibit selection. The Journal of Bone and Joint Surgery. 2015;97(2):e7. doi:10.2106/JBJS.N.00661
Fayad LM, Jacobs MA, Wang X, et al. Musculoskeletal tumors: how to use anatomic, functional, and metabolic MR techniques. Radiology. 2012;265(2):340-356. doi:10.1148/radiol.12111740
Umer M, Hasan OHA, Khan D, et al. Systematic approach to musculoskeletal benign tumors. International Journal of Surgery Oncology. 2017;2(11):e46. doi:10.1097/IJ9.0000000000000046
Resnick D. Diagnosis of bone and joint disorders. 4th ed. Tumors and tumor-like diseases. Philadelphia: PA, Saunders, 2004.
Resnick, D, Kransdorf MJ. Bone and joint imaging. 3rd ed. Philadelphia: Elsevier; 2005.
Mehta K, McBee MP, Mihal DC, et al. Radiographic Analysis of Bone Tumors: A Systematic Approach. Seminars in Roentgenology. 2017;52(4):194-208. doi:10.1053/j.ro.2017.04.002
Helms CA. Osteoid osteoma. The double density sign. Clinical Orthopaedics and Related Research. 1987;(222):167-173.
Kaya T. Kas iskelet - yumuşak doku radyolojisi. Nobel & Güneş Kitabevi, Bursa, 2008.
Brant W, Helms CA. Fundamentals of diagnostic radiology (3rd ed). Musculoskeletal radiology section. Philadelphia: PA, Lippincott; 2007.
Rowe LJ, Yochum TR. Essentials of Skeletal Radi¬ology. 3rd ed. Philadelphia: Lippincott Williams & Wilkins; 2005.
Errani C, Tsukamoto S, Mavrogenis AF. Imaging Analyses of Bone Tumors. JBJS Reviews. 2020;8(3):e0077. doi:10.2106/JBJS.RVW.19.00077
Unni KK, Inwards CY. Dahlin’s bone tumors. 6th edition. Philadelphia: Lippincott; 2010.
White LM, Kandel R. Osteoid-producing tumors of bone. Seminars in Musculoskeleteal Radiology. 2000;4(1):25-43. doi:10.1055/s-2000-6853
Kendell SD, Collins MS, Adkins MC, et al. Radiographic differentiation of enchondroma from low-grade chondrosarcoma in the fibula. Skeletal Radiology. 2004;33(8):458-466. doi:10.1007/s00256-004-0791-9
Levine SM, Lambiase RE, Petchprapa CN. Cortical lesions of the tibia: characteristic appearances at conventional radiography. Radiographics. 2003;23(1):157-177. doi:10.1148/rg.231015088
Murphey MD, Robbin MR, McRae GA, et al. The many faces of osteosarcoma. Radiographics.1997;17(5):1205-1231. doi:10.1148/radiographics.17.5.9308111
Mulligan ME. Myeloma and lymphoma. Seminars in Musculoskelet Radiology. 2000;4(1):127-135. doi:10.1055/s-2000-6860
Touraine S, Emerich L, Bisseret D, et al. Is pain duration associated with morphologic changes of osteoid osteomas at CT?. Radiology. 2014;271(3):795-804. doi:10.1148/radiol.14131629
Liu PT, Chivers FS, Roberts CC, et al. Imaging of osteoid osteoma with dynamic gadolinium-enhanced MR imaging. Radiology. 2003;227(3):691-700. doi:10.1148/radiol.2273020111
James SL, Panicek DM, Davies AM. Bone marrow oedema associated with benign and malignant bone tumours. European Journal of Radiology. 2008;67(1):11-21. doi:10.1016/j.ejrad.2008.01.052
Gronemeyer SA, Kauffman WM, Rocha MS, et al. Fat-saturated contrast-enhanced T1-weighted MRI in evaluation of osteosarcoma and Ewing sarcoma. Journal of Magnetic Resonance Imaging. 1997;7(3):585-589. doi:10.1002/jmri.1880070321
