Quantitative analysis of the plain radiographic appearance of central chondrosarcoma of bone

To quantitate radiographic features that distinguish the plain radiographic appearance of central chondrosarcoma from other solitary bone lesions.

Seven hundred nine cases of focal bone lesions, including 37 central chondrosarcomas, were analyzed according to demographic, anatomic, and plain radiographic features. Vector analysis of groups of features was performed to determine those that are most sensitive and specific for the appearance of central chondrosarcoma in contrast with other lesions in the data base.

The most specific appearance of long bone central chondrosarcomas was a lesion within the medullary cavity with geographic destruction, containing calcified matrix and a diameter greater than 5.9 cm, or arising within the proximal metaphysis or diaphysis. These features all are present in 9 (39%) of the 23 long bone central chondrosarcomas and in less than 1% of other lesions. In flat bone lesions, calcified matrix and either geographic bone destruction, medullary location, or enlargement of the host bone were 100% specific but of low sensitivity, identifying 7 (50%), 7 (50%), and 6 (41%) of the 14 flat bone chondrosarcomas, respectively. Inclusion of calcified matrix in the description is essential to make the criteria specific but excludes several of the most aggressive long bone chondrosarcomas. The vector analysis-generated differential diagnosis include osteosarcoma, fibrous dysplasia, unicameral bone cysts, aneurysmal bone cysts, malignant fibrous histiocytoma, and Ewing sarcoma.

A relatively specific set of radiographic features can be defined to assist in plain film diagnosis of central chondrosarcoma, but there are many chondrosarcomas that fall outside these parameters. Thus, while not sufficiently sensitive to allow accurate plain film diagnosis in all cases, these criteria serve as an improved foundation for differential diagnosis.