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

Abstract

Introduction: The diagnostic process of bone tumors, including malignant ones, is based on conventional radiological methods, such as radiography and computed tomography, and with precise assessment of local advancement in magnetic resonance imaging. Ultrasonography is not included in the diagnostic algorithms as a tool suitable to detect this type of pathology. More and more frequent usage of musculoskeletal ultrasound in children as the first imaging method or, in some cases, as the only diagnostic method, makes it necessary to be familiar with sonographic presentation of bone tumors to suggest this diagnosis early enough and, after its verification, start treatment without a significant delay. Aim: The aim of this study was to determine changes in the sonographic image that might indicate a bone malignancy and suggest the need to extend the diagnostic process in this direction. Material and method: This article discusses 10 bone tumors in 9 children who had an ultrasound scan performed at the beginning of the diagnostic process before the histopathological diagnosis was established and treatment initiated. The assessment involved ultrasonographic features indicating the presence of a tumor. Results: In the group of 9 patients, 8 malignant bone tumors were diagnosed in ultrasonography and later verified histopathologically: 4 osteosarcomas and 4 Ewing’s sarcomas. In one case, two bone tumors were detected in ultrasonography without specification of their nature (malignant/benign, primary/secondary). Conclusions: In the analyzed cases, ultrasonography enabled the correct diagnosis of a focal bone lesion, and in most cases (8/9) it presented an image that suggested its malignant nature and the necessity of further diagnosis and treatment.

Ultrasound Elastography in Musculoskeletal Radiology: Past, Present, and Future

“…28 Inter-estingly, a 2018 article explored the use of USE beyond soft tissue tumors by reporting a case series of bone tumors in children. 31 The authors reported that most malignant bone tumors were very stiff. 31…”

Preliminary image findings of lower limb stress fractures to aid ultrasonographic diagnoses: A systematic review and narrative synthesis

“…Similar findings in inflammatory abnormalities were observed, including osteomyelitis and fractures. 31 Using colour Doppler imaging, ultrasound examines flow direction and velocity within a specified area via intermittent samples of ultrasound waves. 32 This feature allowed for the visualisation of malignant tissue communicating with bone and assessment of neoplasm vasculature without the need to administer contrast media.…”

“…32 This feature allowed for the visualisation of malignant tissue communicating with bone and assessment of neoplasm vasculature without the need to administer contrast media. 31 Additionally, just like MRI, ultrasound was able to categorise tumours morphologically by identifying any cystic components, areas of necrosis or haemorrhagic cysts. 31 An imaging protocol that distinguishes between these differential diagnoses must be developed to reduce the need for radiographic imaging.…”

“…31 Additionally, just like MRI, ultrasound was able to categorise tumours morphologically by identifying any cystic components, areas of necrosis or haemorrhagic cysts. 31 An imaging protocol that distinguishes between these differential diagnoses must be developed to reduce the need for radiographic imaging. 28,29 By identifying key differences between clinical and ultrasonographic presentations, confident diagnoses may be made without risking false negatives.…”

The utility of ultrasound in juvenile idiopathic arthritis

“…It is important that clinicians and radiologists are aware of the range of articular abnormalities that can masquerade as arthritis. This is particularly important when faced with a patient presenting with a monoarticular disease (24,25) . There is also a large group of traumatic lesions, presenting with the same features as JIA like pain, swelling, limited movement.…”