Plain Radiographic Appearance Research Articles

The influence of cartilage thickness at the sigmoid notch on inclination at the distal radioulnar joint.

The aims of this study were: firstly, to investigate the influence of the thickness of cartilage at the sigmoid notch on the inclination of the distal radioulnar joint (DRUJ), and secondly, to compare the sensitivity and specificity of MRI with plain radiographs for the assessment of the inclination of the articular surface of the DRUJ in the coronal plane. Contemporaneous MRI images and radiographs of 100 wrists from 98 asymptomatic patients (mean age 43 years, (16 to 67); 52 male, 53%) with no history of a fracture involving the wrist or surgery to the wrist, were reviewed. The thickness of the cartilage at the sigmoid notch, inclination of the DRUJ and Tolat Type of each DRUJ were determined. The assessment using MRI scans and cortical bone correlated well with radiographs, with a kappa value of 0.83. The mean difference between the inclination using the cortex and cartilage on MRI scans was 12°, leading to a change of Tolat type of inclination in 66% of wrists. No reverse oblique (Type 3) inclinations were found when using the cartilage to assess inclination. These data revealed that when measuring the inclination of the DRUJ using cartilage, reverse oblique inclinations might not exist. The data suggest that performing an ulna shortening osteotomy might be reasonable even in distal radioulnar joints where the plain radiographic appearance suggests an unfavourable reverse oblique inclination in the coronal plane. We recommend using MRI to validate radiographs in those that appear to be reverse oblique (Tolat Type 3), as the true inclination might be different, thereby removing one possible contraindication to ulnar shortening. Cite this article: Bone Joint J 2017;99-B:369-75.

Classifications in Brief: The Hawkins Classification for Talus Fractures.

As reported by Coltart [5], Fabricius von Hilden first described talus injuries in 1608, and in 1919, Anderson et al. [1] reported a series of talus fracture dislocations in which they emphasized dorsiflexion as the mechanism of injury and coined the term ‘‘aviator’s astragalus’’ (astragalus being another term for talus) because of the impressive frequency with which the mechanism—aircraft accidents— was associated with the injury in question. In 1952, Coltart [5] reported on 228 talus injuries treated by surgeons in the British Royal Air Force in an attempt to describe the variety of injuries that occur to the talus and surrounding joints. He described various talus fracture patterns, fracture-dislocation combinations, and isolated peritalar dislocations [5]. Others have presented case series of talus injuries and associated rarely used classification schemes [15, 19], but all have noted high complication rates with injuries to the talus [5, 11, 15, 19]. In 1970, proposed treatment strategies for vertical fractures of the talar neck ranged from nonoperative management to urgent open reduction internal fixation, bone graft augmentation, fusion of the dorsal talus to the distal tibia, and even complete talectomy [11]. Although the importance of early, anatomic reduction of these injuries was noted at that time, the incidence of avascular necrosis (AVN) was not. In 1970 Hawkins [11] described injury patterns and AVN rates in a series of 57 vertical talar neck fractures in 55 patients from three different institutions. All 55 patients sustained forced dorsiflexion injuries, similar to the mechanism described by Anderson et al. [1] in pilots.

Miliary nodules: An unusual presentation of allergic bronchopulmonary aspergillosis.

Allergic bronchopulmonary aspergillosis (ABPA) is an immune-mediated inflammatory disease caused by hypersensitivity to Aspergillus fumigatus. A wide spectrum of plain radiographic appearances has been described in ABPA, though none are pathognomonic of ABPA. The common radiological abnormalities encountered are fleeting pulmonary opacities, bronchiectasis, and mucoid impaction. Uncommon radiological findings encountered in ABPA include pulmonary masses, perihilar opacities simulating hilar adenopathy, and pleural effusions. However, miliary nodules as a radiological presentation of ABPA are very rare and only one case has been reported in literature. It is often misdiagnosed and mismanaged as tuberculosis; thus, the clinician should be vigilant enough to diagnose this very rare entity.

Murine Model of Oligotrophic Tibial Nonunion

This study aimed to use modified distraction osteogenesis techniques to develop a reliable mouse fracture nonunion model with an oligotrophic phenotype. Twenty-six 10- to 14-week-old C57BL/6 male mice underwent a proximal diaphyseal tibial osteotomy with a 2-mm bone resection. An external fixation device was applied to the tibia using cerclage wires. A total of 2.25 mm of distraction was applied over 3 days, resulting in an average distraction gap of 4.28 mm. Plain radiographs were taken at regular intervals until euthanasia at 7 (n = 9), 10 (n = 13), or 12 (n = 4) weeks. After euthanasia, all samples were fixed in formalin, scanned with microcomputed tomography, decalcified in formic acid, prepared in paraffin, and stained with Alcian blue/Mayer's hematoxylin. In the distraction groups, five mice were prematurely euthanized as a result of wound complications stemming from loss of distal fixation. Of the remaining 21, two healed, resulting in a 90% nonunion rate. These nonunions radiographically resembled clinical nonunions with tapered, cone-like fracture ends and histologically demonstrated evidence of attempted healing as seen with cartilage capping. Additionally, the plain radiographic appearance of those nonunions from mice euthanized at 10 and 12 weeks did not change over the final 4 to 6 weeks. The use of 2-mm tibial resection osteotomy with 2-mm distraction provides a predictable model for fracture nonunion in mice with the oligotrophic phenotype closely resembling the clinical correlate. This model offers a promising means for characterization of the molecular events that occur during the development of fracture nonunion and for evaluation of noninvasive methods of nonunion rescue.

Cervical pedicles: Correcting a common misconception

To bring to the attention of Australian radiologists in training, directors of training and radiologists in general, a commonly held erroneous misconception, specifically that of the plain radiographic appearance of the cervical spine pedicle and the transverse process in oblique projections. A human C5 vertebra was appropriately marked and radiographed in the oblique projection to demonstrate key anatomical structures and their relations. The rounded cortical contour overlying the vertebral body is commonly misinterpreted as a cervical transverse process but is the plain radiographic outline of the end-on ipsilateral pedicle. Because of the right-angle relationship of the transverse process long axis and the end-on pedicle long axis, the ipsilateral transverse process appears as a faint elongated corticated structure projecting beyond the vertebral body contour. It may also be obscured because of small size, relative osteopaenia and overlying soft tissue bulk. The end-on pedicle has been unequivocally demonstrated, as has the ipsilateral transverse process. The two lie at right angles to each other. The common misconception (amplified by an error in an earlier edition of a popular atlas) should be debunked by radiologists and should not be promulgated to Australian radiology trainees.

Intermittent small bowel obstruction with retained endoscopic capsule: MDCT and plain radiographic appearance

Originally described by Iddan in 2000 [1], capsule endoscopy (CE) is a technique that evaluates inaccessible portions of the bowel that may elude evaluation during push enteroscopy. The use of CE is increasing as clinical roles are being defined [2–4]. In particular, CE has proven significant incremental diagnostic sensitivity compared with small bowel follow-through in cases of obscure gastrointestinal bleeding [2, 5]. Capsule retention may occur in the presence of small bowel narrowing. With increasing use of the capsule, recognition of the distinctive radiographic and computed tomography (CT) appearance should be made by the radiologist. The plain radiograph and multidetector CT (MDCT) appearance of the PillcamTM (previously known as M2ATM) endoscopic video capsule (GIVEN® Imaging, Yoqneam, Israel) are presented in a patient with small bowel obstruction.

Der interessante Fall: Nora-Läsion am Os metacarpale II eines zwölfjährigen Mädchens

The extremely rare condition of bizarre parosteal osteochondromatous proliferation (BPOP) was first described in 1983 by the pathologist Nora, and a few more than 100 cases have since been reported. The lesion is defined as a reactive heterotopic ossification and is mostly found in the hands or feet of adults in the third decade of life, although it has also been described in long bones and in other age groups. A high rate of local recurrence of up to 50 % has been noted, but the lesion is benign and does not metastasise. An association with chromosomal rearrangements has recently been described. We here report the case of a 12-year-old girl with a BPOP at the second metacarpal bone, thus at an unusual age. The lesion was marginally resected after biopsy, but recurred locally within 2 years, resulting in subtotal resection of the second metacarpal bone, autologous fibula grafting and temporary external fixation. The clinical, plain radiographic and MRI appearance of the lesion and the prominent histological findings are described, and the difficulties in establishing the correct diagnosis in cases of BPOP are discussed.

Langerhans' cell histiocytosis: pathology, imaging and treatment of skeletal involvement.

Langerhans' cell histiocytosis (LCH) is manifested in a variety of ways, the most common being the eosinophilic granuloma, a localized, often solitary bone lesion that occurs predominantly in the pediatric age group. The hallmark of LCH is the proliferation and accumulation of a specific histiocyte: the Langerhans' cell. In bone this may cause pain and adjacent soft-tissue swelling, but some lesions are asymptomatic. LCH can involve any bone, but most lesions occur in the skull (especially the calvarium and temporal bones), the pelvis, spine, mandible, ribs, and tubular bones. Imaging diagnosis of the disease in bone is first based on the plain radiographic appearance, which is usually a central destructive, aggressive-looking lesion. In the skull, the lesions develop in the diploic space, are lytic, and their edges may be beveled, scalloped or confluent (geographic), or show a "button sequestrum." Vertebral body involvement usually causes collapse, resulting in vertebra plana. With significant recent improvements in the quality of gamma cameras, imaging techniques, and in studying children, bone scintigraphy at diagnosis and on follow-up usually reveals the sites of active disease, especially when the involvement is polyostotic. CT and MR imaging are very useful in providing detailed cross-sectional anatomic detail of the involved bone, including the bone marrow and the adjacent soft tissues. CT is better suited for demonstrating bone detail and MR imaging for bone marrow and soft-tissue involvement.

Acetabular retroversion is associated with osteoarthritis of the hip.

Primary osteoarthritis of the hip may have a structural basis. It was hypothesized that the radiographic appearance of acetabular retroversion could be created by altering the morphologic features of the acetabular walls, and that acetabular retroversion, as defined on an anteroposterior radiograph of the pelvis, is associated with osteoarthritis of the hip. A model pelvis was used to simulate normal, augmented, deficient, and rotated walls of the acetabulum, and radiographs were taken to compare the projections of the modified acetabular walls with the known plain radiographic appearance of a retroverted acetabulum. One hundred thirty-one good quality anteroposterior radiographs of the pelvis taken before total hip arthroplasty for idiopathic hip osteoarthritis were compared with 99 good quality radiographs taken for nonorthopaedic reasons. The prevalence of radiographic acetabular retroversion is 20% among patients with idiopathic hip osteoarthritis and 5% among the general population. The appearance of acetabular retroversion on an anteoroposterior radiograph of the pelvis is created by deficiency of the posterior wall of the acetabulum. There is a statistically significant association between radiographic acetabular retroversion and hip osteoarthritis. These findings have applicability to understanding the mechanical etiology of hip osteoarthritis, and to surgical technique during periacetabular osteotomy and total hip arthroplasty.

Natural evolution of Perthes disease: a study of 610 children under 12 years of age at disease onset.

Records and 2,634 pairs of radiographs (anteroposterior and lateral) of 610 patients with Perthes disease were reviewed. The evolution of the disease was divided into seven stages (stages Ia, Ib, IIa, IIb, IIIa, IIIb, and IV) based on plain radiographic appearances. Intraobserver and interobserver reproducibility of this new classification system was assessed. The duration of each stage of the disease was noted. The stages at which epiphyseal extrusion and widening of the metaphysis occurred and the stages at which metaphyseal and acetabular changes appeared were identified. The shape and the size of the femoral head, the extent of trochanteric overgrowth, and the radius of the acetabulum were assessed in hips that had healed. The new classification system of the evolution of Perthes disease was reproducible and helped to identify when crucial events occur during the course of the disease. The median duration of each stage varied between 95 and 335 days. Epiphyseal extrusion and metaphyseal widening was modest in stages Ia, Ib, and IIa but increased dramatically after stage IIb. More than 20% extrusion occurred in 70% of the hips by stage IIIa. Metaphyseal changes were most frequently encountered in stage IIb, while acetabular changes were most prevalent in stage IIIa. At healing, only 24% of untreated patients had spherical femoral heads, while 52% had irregular femoral heads. The timing of epiphyseal extrusion, metaphyseal widening, and the appearance of adverse metaphyseal and acetabular changes suggest that femoral head deformation occurs by stage IIIa in untreated hips. Hence, if containment were to succeed, it should be achieved before this stage.

Clinical evaluation of inferior vena cava filters in patients with deep vein thrombosis

The titanium Greenfield filter (TGF) is widely accepted for its efficacy, high patency, and low complication rate. Between November 1998 and April 2000, six patients underwent placement of titanium Greenfield filters at Tokoro Memorial Hospital. Three patients were at high risk for pulmonary embolism (PE), two were at risk for anticoagulation therapy, and, one had a proven PE. One patient died 9 months after filter insertion from a cerebral hemorrhage. Inability to pass the pelvic vein via the left femoral vein was encountered in one case at the time of placement. Plain abdominal films revealed that filter angulation (off-axis position) was confirmed in four cases. Two cases of filters were well centered in the inferior vena cava (IVC). The mean angulation was 6 ± 2.3 degrees. The plain radiographic appearance of the filter suggested asymmetric distribution of the filter struts in four cases. Four cases were examined by plain abdominal computed tomography (CT), and IVC penetration was recognized in all cases. Clinically relevant recurrent PE, cephalad or caudal migration, changes of filter span, and mechanical fracture of the strut were not recognized after TGF placement. Problems of angulation, penetration of the IVC wall, and asymmetric distribution of the filter struts were observed, but all patients were asymptomatic after filter insertion. In the future, more cases need to be studied for a better evaluation of late complications.

Chest Radiology: The Essentials

Book ReviewsChest Radiology: The Essentials Sarwat HussainFRCR, DABR Sarwat Hussain Professor and Chairman, Department of Radiology, MBC 28, King Faisal Specialist Hospital & Research Centre, P.O. Box 3354 Riyadh 11211, Saudi Arabia Search for more papers by this author Published Online::1 May 2000https://doi.org/10.5144/0256-4947.2000.339bSectionsPDF ToolsAdd to favoritesDownload citationTrack citations ShareShare onFacebookTwitterLinked InRedditEmail AboutIntroductionEdited by Jannette Collins and Eric Stern. Available from Lippincott Williams and Wilkins, 1999. P.O. Box 1640, Hagerstown, MD 21741-1640, USA. Price: US$79. ISBN: 0-7817-1582-2.This book is based on a highly successful review course on chest radiology given by the authors. The contents of the course have been updated, enlarged and refined in this current book form. The hard-bound book has been organized into 18 chapters. The first two chapters provide an overview of the normal chest anatomy through line drawings superimposed on radiographs and richly labeled computed tomography (CT) images. This method of teaching is time tested and effective. This reviewer also uses the superimposition method with success in teaching medical students and junior residents. In describing the radiographic signs in “Chest Radiology” (Chapter 2), the authors have generously illustrated the contents by plain radiographs with CT correlation. But there are no slides for pathological correlation. The body of the book (chapters 3 through 13) describes disease pattern by anatomical location of the pathology, for example, CT and plain radiographic appearance of interstitial and alveolar lung disease, mediastinal and pleural pathology and other similar classifications. Chapter 14 deals with the analysis of a radiographic sign of unilateral hyperlucent lung, a commonly encountered radiographic problem. The important topics of neoplasms of the lung and disease pattern in immunocompromised patients are dealt with in separate chapters towards the end. Chapter 18 provides well-illustrated radiographs and CT scans for self-assessment review. The radiological illustrations are of very high quality.Learning objectives are enumerated at the beginning of every chapter, which will certainly help students, radiology residents, as well as clinicians to focus on relevant information. This book, as the authors concede, cannot be considered a source of reference in chest radiology, but it certainly fulfills the intended objective of providing the essentials of the subject. Medical students, residents, fellows, and even junior staff should find it a valuable source of relevant and reliable information. Stress has been laid on the understanding of the pathogenesis of the radiological findings rather than mere knowledge of facts in chest imaging.The absence of magnetic resonance (MR) illustrations seems to be intentional, as the majority of MR applications relate to the cardiovascular system and are not essential in the diagnosis of the diseases of the lungs and bronchi. Magnetic resonance imaging seems to be outside the scope of this book, however, a few MR images are included in chapter 17, where a brief discussion of the imaging of the cardiovascular system is presented.Both authors completed the Figley Fellowship in Radiology Journalism and have extensive teaching and publishing experience. One of the authors (JC) also has a Master's Degree in Education. The authors' teaching experience is reflected in the style and the organization of the book. The language used is simple and the description of the chapters revolves around the learning objective. References are made to relevant articles at the end of each chapter. The gamut of differential diagnoses is provided in easy-to-remember tables of acronyms. My favorite is CHIHUAHUAH for the 10 causes of pulmonary edema with a normal heart size!Each chapter deals with the practical aspect of its topic. Some of the best chapters include interstitial and alveolar lung disease and monitoring and support devices, i.e., tubes and lines. Chest Radiology: The Essentials should be part of all Department of Radiology and Department of Medicine libraries, especially in departments that are involved in teaching residents. Previous article Next article FiguresReferencesRelatedDetails Volume 20, Issue 3-4May-July 2000 Metrics History Published online1 May 2000 InformationCopyright © 2000, Annals of Saudi MedicinePDF download

Quantitative analysis of the plain radiographic appearance of unicameral bone cysts.

The authors determine the features that distinguish the radiographic appearance of unicameral bone cysts (UBC) from other solitary lesions of bone and to develop an ordered differential of similar-appearing lesions. Seven hundred nine cases of solitary bone lesions, including 40 UBCs, were analyzed according to demographic, anatomic, and plain radiographic features. Vector analysis of both classic and new groups of features was performed to determine the sensitivity and specificity of radiographs for UBC and an ordered differential based on radiographic features. The features of the UBCs in this study compared favorably with those in the literature. The male:female ratio was 3.3:1, with an average age of 15 +/- 13 years. Age ranges and lesion diameters were similar for both sexes. Thirty-three of the 40 (83%) UBCs were in long bones, and seven were in the pelvis or calcaneus. All 40 UBCs were geographic, medullary, and lytic. None had an associated soft-tissue mass. Fifty-five percent had pathologic fractures, and 10% had fallen fragment signs. Ninety-eight percent had no cortical break, and 88% had well-defined margins. Classic descriptions of UBCs can be refined to improve sensitivity without sacrificing specificity. The best vector in this study had a sensitivity of 80% and a specificity of 93% and included these radiographic features: metaphyseal, diaphyseal, or flat bone location, geographic, lytic, medullary-based, no matrix, no satellite lesions, no subarticular extension, no soft-tissue mass, no cortical break, and central location in long bones. An ordered differential diagnosis, starting with the most likely lesion, includes enchondroma, aneurysmal bone cyst, fibrous dysplasia, nonossifying fibroma, Brodie abscess, and chondrosarcoma.

Intraosseous lipomata of adjacent vertebral bodies

Osseous lipomata of vertebral bodies are rare. We present a very unusual case where adjacent vertebrae are involved and the plain radiographic and scintigraphic appearances gave cause for some concern. The findings on plain films, scintigraphy, computed tomography and magnetic resonance imaging are discussed.

The normal cervical spine and its variations on plain radiography and computed tomography

To detect abnormalities of the injured bony cervical spine, it is necessary to have a thorough knowledge of the normal cervical spine’s anatomy and its variations. It is the purpose of this article to emphasize the visual characteristics of the normal appearances in order to assist in the determination of whether the examination is normal or abnormal. Because of these visual characteristics, it is at times possible to be certain that the examination is normal solely on basis of the plain radiographs. On other occasions, because the plain radiographic appearance of normal and abnormal may overlap, further evaluation with computed tomography is necessary. Rarely, even with computed tomography, the appearance of normal, subacute injury, and acute injury may not be distinguishable.

Quantitative analysis of the plain radiographic appearance of Ewing's sarcoma of bone.

The authors quantitate the radiographic features that distinguish the plain radiographic appearance of Ewing's sarcoma (ES) from other solitary lesions of bone. A total of 709 cases of focal bone lesions, including 44 ES, were analyzed according to demographic, anatomic, and plain radiographic features. Vector analysis of groups of features was performed to determine those that are most sensitive and specific for the appearance of ES in contrast with other lesions in the database. In our sample, Ewing's sarcoma is most consistently a medullary-based (91%) lytic (89%) lesion with at least a partially permeative appearance (82%), poorly defined edges (82%), no margination (91%), and a soft-tissue mass (61%). When these lesions occur in long bones, they most commonly are found in the diaphysis (75%) and are proximal more often than distal. Vector analysis suggests that any primary bone lesion without radiographically visible matrix and with either a soft-tissue mass, an appearance of permeative destruction alone or in combination with other patterns of bone destruction is suspect for the diagnosis. This small subset of common features appears to have a high sensitivity (89%) and prevalence (47%) of ES among the lesions meeting these criteria. Limiting the age of the patients to progressively younger age groups increases the specificity but lowers sensitivity. The vector analysis-generated differential diagnoses includes osteosarcoma, giant-cell tumor, lymphoma, and chondrosarcoma. A relatively specific set of radiographic features can be defined, which will assist in the radiographic diagnosis of ES and improve upon current textbook descriptions.

Quantitative analysis of the plain radiographic appearance of eosinophilic granuloma

RATIONALE AND OBJECTIVES To quantitate features that distinguish the plain radiographic appearance of eosinophilic granuloma (EG) from other solitary lesions of bone. MATERIALS AND METHODS Seven hundred nine focal bone lesions, including 26 EGs, were analyzed according to demographic, anatomic, and plain radiographic features. Vector analysis of groups of features was performed to determine those that are most sensitive and specific for the appearance of EG in contrast to other lesions in the data base. RESULTS The radiographic appearance of EGs was most consistently that of a medullary based lytic lesion (100%) with geographic destruction (76.9%), lobular contour (73.1%), and well-defined edges (73.1%). Long bone lesions showed these features more frequently than EGs in other locations. Periosteal reaction was visible in all long bone lesions but in only one nonlong bone lesion (5.9%). Characterization of EG in long bones as a lytic, medullary-based metaphyseal or diaphyseal lesion with geographic destruction, lobular contours, periosteal reaction, no matrix, and no subarticular extension showed a sensitivity of 55.6% of EG and prevalence of 22.7%. The vector analysis-generated differential diagnoses include unicameral bone cyst, aneurysmal bone cyst, giant cell tumor, Brodie's abscess, enchondroma, chondrosarcoma, and malignant fibrous histiocytoma. CONCLUSIONS The radiographic appearance of EG is relatively nonspecific but, using vector analysis, can be better elucidated than in current textbook descriptions.

CT appearances of intrathoracic Kaposi's sarcoma in patients with AIDS.

Although there have been many studies of the plain radiographic appearances of intrathoracic Kaposi's sarcoma in patients with the acquired immunodeficiency syndrome, the computed tomography (CT) findings are less well established. We performed a retrospective review of the thoracic CT findings of 15 patients with tracheobronchial Kaposi's sarcoma diagnosed at bronchoscopy in whom concurrent respiratory infection had been excluded. The commonest CT finding was the presence of ill-defined nodules, seen in all patients. In eight patients more than 20 nodules were seen. Small areas of ground-glass attenuation surrounded one or more nodules in 11 patients. Bilateral perihilar infiltrates were seen in 14 patients, extending into the pulmonary parenchyma along bronchovascular bundles. Interlobular septal thickening was seen in 13 patients and fissural nodularity in 15 patients. To our knowledge this latter finding has not been described before. Discrete areas of ground-glass attenuation were seen in six patients. Small bilateral pleural effusions occurred in six patients; four patients had a pericardial effusion. Shotty mediastinal lymphadenopathy occurred in six patients, and mediastinal nodes greater than 1 cm were present in four patients. None of the patients had CT evidence of chest wall or bone involvement. Although none of these findings are specific, the combination of poorly defined nodules, fissural nodularity and a bronchovascular distribution of perihilar opacities on CT is highly suggestive of pulmonary Kaposi's sarcoma.

Quantitative analysis of the plain radiographic appearance of nonossifying fibroma.

To quantitate radiographic features that distinguish the plain radiographic appearance of nonossifying fibroma (NOF) from other solitary lesions of bone. Seven hundred nine cases of focal bone lesions, including 34 NOFs, were analyzed according to demographic, anatomic, and plain radiographic features. Vector analysis of groups of features was performed to determine those that are most sensitive and specific for the appearance of NOF in contrast to other lesions in the data base. The radiographic appearance of NOFs was most consistently a medullary based (97%), lytic lesion (100%) with geographic bone destruction (100%), marginal sclerosis (97%), and well-defined edges (94%). A statistically significant number of lesions were located in the distal aspect of long bones. Unicameral bone cyst shared the most radiographic features with the NOF. Vector analysis showed a large degree of overlap between NOF and other lesions such as aneurysmal bone cyst, chondromyxoid fibroma, and eosinophilic granuloma. The description that optimized sensitivity and prevalence for detection of NOF is a medullary based, ovoid lesion in the distal or proximal portions of a long bone with well-defined edges, a partial or complete rind of sclerosis, and absence of fallen fragment, periosteal reaction, and cortical disruption. The radiographic appearance of NOF is relatively nonspecific but, using vector analysis, can be better elucidated over current textbook descriptions.

Quantitative Analysis of the Plain Radiographic Appearance of Eosinophilic Granuloma

To quantitate features that distinguish the plain radiographic appearance of eosinophilic granuloma (EG) from other solitary lesions of bone. Seven hundred nine focal bone lesions, including 26 EGs, were analyzed according to demographic, anatomic, and plain radiographic features. Vector analysis of groups of features was performed to determine those that are most sensitive and specific for the appearance of EG in contrast to other lesions in the data base. The radiographic appearance of EGs was most consistently that of a medullary based lytic lesion (100%) with geographic destruction (76.9%), lobular contour (73.1%), and well-defined edges (73.1%). Long bone lesions showed these features more frequently than EGs in other locations. Periosteal reaction was visible in all long bone lesions but in only one nonlong bone lesion (5.9%). Characterization of EG in long bones as a lytic, medullary-based metaphyseal or diaphyseal lesion with geographic destruction, lobular contours, periosteal reaction, no matrix, and no subarticular extension showed a sensitivity of 55.6% of EG and prevalence of 22.7%. The vector analysis-generated differential diagnoses include unicameral bone cyst, aneurysmal bone cyst, giant cell tumor, Brodie's abscess, enchondroma, chondrosarcoma, and malignant fibrous histiocytoma. The radiographic appearance of EG is relatively nonspecific but, using vector analysis, can be better elucidated than in current textbook descriptions.