Cortical Lesions of the Tibia: Characteristic Appearances at Conventional Radiography

http://radiographics.rsna.org/content/23/1/157.full

Scott M. Levine, MD ; Robert E. Lambiase, MD ; Catherine N. Petchprapa, MD

1 From the Department of Diagnostic Imaging, Brown University Medical School, Rhode Island Hospital, 593 Eddy St, Providence, RI 02903 (S.M.L., R.E.L.); and the Department of Radiology, Harvard Medical School, Massachusetts General Hospital, Boston, Mass (C.N.P.). Recipient of a Certificate of Merit award for an education exhibit at the 2000 RSNA scientific assembly. Received April 18, 2001; revision requested July 26; final revision received May 15, 2002; accepted May 17.

Lesions that involve the cortex of the tibia are fairly common in radiology practice. However, the number of diseases that involve the tibial cortex is great, and it can be difficult to arrive at a limited differential diagnosis from radiographic findings. Categorization of lesions of the tibia into those that cause cortical destruction and those that cause cortical proliferation can help narrow the broad differential diagnosis. Lesions that cause cortical destruction include nonossifying fibroma, fibrous dysplasia, osteofibrous dysplasia, aneurysmal bone cyst, giant cell tumor, eosinophilic granuloma, Ewing sarcoma, neurofibromatosis, adamantinoma, osteoblastoma, chondromyxoid fibroma, hemangioendothelioma, renal cell metastatic disease, hemangioma, and hemangiopericytoma. Lesions that cause cortical proliferation include osteochondroma, stress fracture, osteoid osteoma, periosteal osteogenic sarcoma, diaphyseal dysplasia, venous stasis, cellulitis, chronic osteomyelitis, osteopathia striatum, and melorheostosis. Conventional radiography along with clinical and pathologic data can aid in diagnosis of the wide variety of disease processes that involve the tibial cortex.