A. Zelazny et al., QUANTITATIVE-ANALYSIS OF THE PLAIN RADIOGRAPHIC APPEARANCE OF EWINGS-SARCOMA OF BONE, Investigative radiology, 32(1), 1997, pp. 59-65
RATIONALE AND OBJECTIVES. The authors quantitate the radiographic feat
ures that distinguish the plain radiographic appearance of Ewing's sar
coma (ES) from other solitary lesions of bone. METHODS. A total of 709
cases of focal bone lesions, including 44 ES, were analyzed according
to demographic, anatomic, and plain radiographic features, Vector ana
lysis of groups of features was performed to determine those that are
most sensitive and specific for the appearance of ES in contrast with
other lesions in the database. RESULTS. In our sample, Ewing's sarcoma
is most consistently a medullary-based (91%) lytic (89%) lesion with
at least a partially permeative appearance (82%), poorly defined edges
(82%), no margination (91%), and a soft-tissue mass (61%), When these
lesions occur in long bones, they most commonly are found in the diap
hysis (75%) and are proximal more often than distal, Vector analysis s
uggests that any primary bone lesion without radiographically visible
matrix and with either a soft-tissue mass, an appearance of permeative
destruction alone or in combination with other patterns of bone destr
uction is suspect for the diagnosis, This small subset of common featu
res appears to have a high sensitivity (89%) and prevalence (47%) of E
S among the lesions meeting these criteria. Limiting the age of the pa
tients to progressively younger age groups increases the specificity b
ut lowers sensitivity. The vector analysis-generated differential diag
noses includes osteosarcoma, giant-cell tumor, lymphoma, and chondrosa
rcoma. CONCLUSIONS. A relatively specific set of radiographic features
can be defined, which will assist in the radiographic diagnosis of ES
and improve upon current textbook descriptions.