Typical X-ray manifestations of bone cancer

Frontal and lateral X-rays are one of the most important diagnostic methods for bone cancer, which can reflect the basic lesions of bones and soft tissues. Tumor destruction in bones includes osteolytic type, osteoblastic type and mixed type. The reactive bone of some bone tumors can show bone deposition, which is clinically called osteoma bone.

Bone cancer grows rapidly, and the lesions are often irregular, with uneven density and unclear boundaries. The bone destruction areas are irregular and appear worm-eaten or sieve-like. If the periosteum is lifted by the tumor, new bone can be generated under the periosteum. This triangular periosteal reaction shadow seen on the X-ray is called the Codman triangle, which is more common in osteosarcoma. If the lifting of the periosteum is staged, concentric circles or layered bone deposits can be formed, which appear as onion skin on X-rays, and are more common in Ewing sarcoma. If the tumor grows rapidly and exceeds the range of the bone cortex, blood vessels will grow in, and the tumor bone and reaction bone will be deposited along the radial blood vessels, showing the state of sunlight exposure. However, some rapidly growing bone cancers do not have reaction bones. X-rays show osteolytic defects and bone destruction, and pathological fractures can be seen.