Radiographs are not extremely sensitive in the detection of small amounts of bone destruction, especially destructive focus is located in cancellous bone. Cortical lesions are detected more readily than those in cancellous bone. In some sites, such as the diaphyses of tubular bones, few trabeculae are present in the medullary canal, so radiographic identification of a lesion is extremely difficult.

In fact, detection of a sharply marginated radiolucent area overlying the medullary portion of a tubular bone (especially a large one) in a single radiographic projection almost always implies cortical involvement, which readily becomes apparent when a second projection is obtained. In certain sites, such as the ribs and spine, technical factors, including the size or thickness of the body part and the presence of considerable overlying shadows, accentuate the radiograph’s insensitivity in delineating small lesions. [Read more...]