Different Patterns of Destruction In Bone Disease

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.

Still graph’s insensitivity in delineating small lesions. Still, even with optimal technique, the destruction of all cancellous trabeculae may ot be detected with routine radiography if the surrouding cortex is not affected.

Three radiographic patterns of bone destruction have been identified:

• Geographic
• Motheaten
• Permeative.

Geographic Bone Destruction

The geographic pattern is the least aggressive patern of bone destruction, and it is generally indicative of a slowly growing lesion. The margin of the lesion is well defined and easily separated from the surrounding normal bone.

This margin may be smooth or irregular, but in either instance, it is usually clearly demarcated, with a short zone of transition from normal to abnormal bone.

In some instance, a sclerotic margin of variable thickness surrounds the lesion. The thicker and more complete the sclerotic margin, the les aggressive the process. Benign bone tumors usually demonstrate geographic bone destruction. Malignant diseases (such as plasma cell myeloma and metastasis) and osteomyelitis (particularly granulomatous infections) can demonstrate a similar pattern of bone destruction, however.

Motheaten Bone Destruction

The motheaten pattern is a more aggressive pattern of bone destruction and is characteristic of a lesion that is growing more rapidly than one that demonstrates geographic bone destruction. The motheaten pattern of bone destruction is associated with a less well defined or demarcated lesion margin and with a longer zone of transition from normal to abnormal bone.

Malignant bone tumors and osteomyelitis may demonstrate the motheaten pattern of bone destruction. Some benign processes, such as eosinophilic granuloma, may be associated with motheaten bone destruction, however.

Permeative Bone Destruction

The permeative pattern indicates an aggressive bone lesion with rapid growth potential. The lesion is poorly demarcated and not easily separated from the surrounding normal bone. In fact, it may imperceptibly merge with uninvolved osseous segments and create a zone of transition that is very long.

Its true size is larger than that evident on radiographs. Certain malignant bone tumors, such as Ewing’s sarcoma, may demonstrate permeative bone destruction. Osteomyelitis and rapidly developing osteoporosis, as in reflex sympathetic dystrophy, may reveal permeative bone destruction, however.

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