RADIOGRAPHIC DIFFERENTIATION OF OSTEOGENIC-SARCOMA, OSTEOMYELITIS, AND FIBROUS DYSPLASIA OF THE JAWS

Biopsy and histopathologic analysis may fail to consistently separate osteogenic sarcoma, osteomyelitis, and fibrous dysplasia. Objectives. To establish useful radiographic characteristics to differentiate thes e diseases, an objective preliminary study of radiographs of 30 cases of these diseases was done. Study design. After precisely defining sev eral radiographic characteristics and completing a calibration study, three observers unaware of the diagnosis examined study cases that wer e randomly ordered. Results. Despite using trained observers and stric t criteria, differentiation of the three conditions is difficult on th e basis of radiographic features alone. in osteogenic sarcoma, the dis tinguishing features were: permeative lesion borders. stippled bone pa ttern, destruction of cortical outlines, perpendicular spiculations oi periosteal new bone, destruction of lamina dura, and widening of the entire periodontal ligament space. Presence of sequestra and laminatio ns of periosteal new bone were the most useful distinguishing features in cases of osteomyelitis that otherwise resemble fibrous dysplasia. In fibrous dysplasia, superior displacement of the mandibular canal an d a fingerprint bone pattern were pathognomonic, Displacement of the m axillary sinus cortex, alteration of lamina dura to the abnormal bone pattern, and narrowing si the periodontal ligament space were also use ful distinguishing features. Conclusions. Our findings indicate that d iagnosis cannot rely on radiographic characteristics alone, although s ome radiographic findings were more useful than others.