Comparative Imaging Study In Children Osteomyelitis And Osteosarcoma Of Long Tubular Bones

Objective:To investigate the value of imaging findings in the differential diagnosis between children osteomyelitis and osteosarcoma of long tubular bones.Materials and Methods:The imaging findings in 89 pediatric cases of osteomyelitis and 62 pediatric cases of osteosarcoma in long tubular bones were retrospectively defined, observed, recorded and statistically analyzed. In all the 89 cases of osteomyelitis,65 cases were examined with radiograph,54 cases with CT and 31 cases with MRI. In all the 62 cases of osteosarcoma,52 cases were examined with radiograph,36 cases with CT and 28 cases with MRI.Results:In all the 89 cases of osteomyelitis and 62 cases of osteosarcoma, neoplastic bone and neoplastic-bone-like finding in soft tissue mass were presented in 1 and 34 cases, radiating osseous spicules in soft tissue mass in 1 and 25 cases, respectively. Among 82 cases of osteomyelitis and 59 cases of osteosarcoma examined with radiograph and (or) CT, round and ovoid osteolytic focuses appeared in 22 cases and 5 cases respectively, an area of bone destruction with special shape in 12 cases and 0 case, an osteolytic lesions with a sharp sclerotic margin in 15 cases and 1 case, an area of bone destruction on surface in 18 cases and 4 cases, an area of cortical destruction similar to sinus tract in 11 cases and 0 case, sequester in 10 cases and 0 case, a sequester-like sign in 15 cases and 3 cases, wide-strip-like periosteal proliferation in 19 cases and 4 cases, thickening of cortex in 31 cases and 4 cases, an osteolytic lesion with a discontinuous, expansile, ossified shell in 1 case and 15 cases, a sclerotic focus in 0 case and 16 cases, Codman’s triangle in 7 cases and 32 cases, and a ossified margin on soft tissue mass in 1 case and 12 cases. In 67 cases of osteomyelitis and 43 cases of osteosarcoma examined with CT and (or) MR, soft tissue masses occurred in 3 cases and 35 cases, and fat-fluid level in 3 cases and 0 case, respectively. Among 31 cases of osteomyelitis and 28 cases of osteosarcoma examined with MR, intraosseous strip-like signals appeared in 8 cases and 0 case respectively, intraosseous abscesses in 9 cases and 0 case, skipped lesions in 0 case and 6 cases, intraosseous masses in 0 case and 15 cases, and fluid level in 0 case and 10 cases. The occurrence frequency of all above mentioned imaging signs showed significant difference (p<0.05) between osteomyelitis group and osteosarcoma group.Conclusion:The occurrence frequency of many X-ray, CT and MR findings were different between children osteomyelitis and children osteosarcoma of long tubular bones, and were valuable for the differential diagnosis.