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Ultrasound image of malignant bone tumors in children. An analysis of nine patients diagnosed in 2011–2016

Tomasz Madej
Tomasz Madej
, 
Joanna Flak-Nurzyńska
Joanna Flak-Nurzyńska
, 
Ewa Dutkiewicz
Ewa Dutkiewicz
, 
Anna Ciechomska
Anna Ciechomska
, 
Jerzy Kowalczyk
Jerzy Kowalczyk
 and 
Andrzej Paweł Wieczorek
Andrzej Paweł Wieczorek
   | Aug 31, 2018
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Article Category: original-paper
Published Online: Aug 31, 2018
Page range: 103 - 111
Received: Jan 15, 2018
Accepted: Jun 29, 2018
DOI: https://doi.org/10.15557/jou.2018.0015
Keywords
© 2018 Tomasz Madej et al., published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Fig. 1.

Patient P.K. Osteosarcoma. An osteolytic tibial defect of uneven outline filled with heterogeneous hypoechoic pathological tissue
Patient P.K. Osteosarcoma. An osteolytic tibial defect of uneven outline filled with heterogeneous hypoechoic pathological tissue

Fig. 2.

Patient D.M. Ewing’s sarcoma. A pathological tumor mass emerging from the end of the shoulder clavicle with visible clavicle destruction: uneven bone outline and partial penetration of the ultrasound wave to the infiltrated bone
Patient D.M. Ewing’s sarcoma. A pathological tumor mass emerging from the end of the shoulder clavicle with visible clavicle destruction: uneven bone outline and partial penetration of the ultrasound wave to the infiltrated bone

Fig. 3.

Patient Z.K. Osteosarcoma. Femoral tumor. A subperiosteal pathological mass with visible hyperechoic reflections indicating neoplastic mineralization with a tendency to their radial arrangement (red arrow). On the left side of the image, one may notice visible features of tumor invasion in the periosteum with a slight hypoechoic nodule (blue arrow)
Patient Z.K. Osteosarcoma. Femoral tumor. A subperiosteal pathological mass with visible hyperechoic reflections indicating neoplastic mineralization with a tendency to their radial arrangement (red arrow). On the left side of the image, one may notice visible features of tumor invasion in the periosteum with a slight hypoechoic nodule (blue arrow)

Fig. 4.

Patient P.K. Osteosarcoma. An osteolytic lesion of the tibia, as in Fig. 1. Power Doppler imaging shows numerous vessels on the periphery of the lesion, thereby confirming the tissue nature of the pathological mass that occupies the bone defect (yellow arrow). Additionally, one may notice thickening, edema and hyperemia of the periosteum (blue arrow)
Patient P.K. Osteosarcoma. An osteolytic lesion of the tibia, as in Fig. 1. Power Doppler imaging shows numerous vessels on the periphery of the lesion, thereby confirming the tissue nature of the pathological mass that occupies the bone defect (yellow arrow). Additionally, one may notice thickening, edema and hyperemia of the periosteum (blue arrow)

Fig. 5.

Patient E.W. Ewing’s sarcoma. Femoral shaft tumor. A. Panoramic imaging helps assess the total longitudinal size of the tumor (8 cm) and more clearly shows the relationship of the lesion with the bone. In the distal part of the lesion, one can notice a sharp bone of the “rose thorn” morphology, which corresponds with the radiographic Codman’s spur (yellow arrow). Uneven outline of the cortical bone adjacent to the bone. B. Radiography of the femoral tumor (blue arrow)
Patient E.W. Ewing’s sarcoma. Femoral shaft tumor. A. Panoramic imaging helps assess the total longitudinal size of the tumor (8 cm) and more clearly shows the relationship of the lesion with the bone. In the distal part of the lesion, one can notice a sharp bone of the “rose thorn” morphology, which corresponds with the radiographic Codman’s spur (yellow arrow). Uneven outline of the cortical bone adjacent to the bone. B. Radiography of the femoral tumor (blue arrow)

Fig. 6.

Patient P.S. Osteosarcoma. A tumor in the distal femur. An extraosseous mass in the popliteal fossa. Cystic areas within the tumor mass (yellow arrow)
Patient P.S. Osteosarcoma. A tumor in the distal femur. An extraosseous mass in the popliteal fossa. Cystic areas within the tumor mass (yellow arrow)

Fig. 7.

Patient K.G. A. Bone lymphoma in the tibia. A lesion in the proximal metaphysis of the left tibia. A low-signal subperiosteal mass that separates the periosteum with blurred outline of the cortex adjacent to the bone (yellow arrow). B. A pathological mass in the same location with signs of vascularization in power Doppler imaging. C. Bone lymphoma in the left tibia in CT: a poorly visible pathological tissue mass at the cortical bone in the anteromedial part of the tibia (red arrow). D. Bone lymphoma in the frontal bone in the bone window (blue arrow) and ( E ) in the soft tissue window following contrast medium administration—intensive enhancement of the tumor (blue arrow)
Patient K.G. A. Bone lymphoma in the tibia. A lesion in the proximal metaphysis of the left tibia. A low-signal subperiosteal mass that separates the periosteum with blurred outline of the cortex adjacent to the bone (yellow arrow). B. A pathological mass in the same location with signs of vascularization in power Doppler imaging. C. Bone lymphoma in the left tibia in CT: a poorly visible pathological tissue mass at the cortical bone in the anteromedial part of the tibia (red arrow). D. Bone lymphoma in the frontal bone in the bone window (blue arrow) and ( E ) in the soft tissue window following contrast medium administration—intensive enhancement of the tumor (blue arrow)

Fig. 8.

Patient P.S. Osteosarcoma. A tumor in the soft tissues of the popliteal fossa in elastography. The lesion coded in blue; a stiff lesion
Patient P.S. Osteosarcoma. A tumor in the soft tissues of the popliteal fossa in elastography. The lesion coded in blue; a stiff lesion

Morphological features of bone tumors in US

Initials Location Presence of a tumorous mass Echogenicity Homogeneity Bone destruction Periosteal separation Periosteal reactions Size Vasculature Elastography Additional signs
P.K. tibia present lower heterogeneous present present absent 5 cm rich mixed stiffness regions of tumor mineralization
D.C. femur present lower heterogeneous present present present 10 cm rich stiff
Ł.A. rib present lower heterogeneous present invisible invisible 11 cm enhanced not performed infiltration of the soft tissues of the chest, pleural fluid
Z.K. femur present lower heterogeneous present present with loss of continuity present no data rich stiff
G.K. frontal bone present lower homogeneous present/blurred cortical bone present invisible 4.5 cm moderate not performed
G.K. tibia present lower homogeneous slight/blurred cortical bone present invisible 4 cm rich not performed
P.S. femur present lower heterogeneous present present with loss of continuity present 12 cm rich stiff extraosseous tumor in the popliteal fossa, lymph nodes
K.W. femur present lower heterogeneous present present present 8 cm rich stiff
D.M. clavicle present lower heterogeneous present present present 7 cm rich stiff
P.B. rib present lower heterogeneous present invisible present 15 cm moderate not performed pleural implants, fluid

Patient data, tumor location and causes for ordering a US scan

Initials Sex Age Year of examination Tumor location Cause stated on the referral
P.K. M 14 2011 right tibia local edema
D.C. M 14 2012 left femur persisting posttraumatic edema
Ł.A. M 12 2012 10th right rib abdominal pain
Z.K. F 13 2013 left femur joint edema
K.G. M 12 2014 frontal bone/tibia nodule in the frontal region/pain in the lower leg
P.S. F 15 2014 left femur tumor in the popliteal fossa
K.W. F 13 2014 right femur thickening in the thigh
D.M. F 15 2015 right clavicle suspicion of arthritis in the ACJ
P.B. M 16 2016 7th left rib shortness of breath
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