Radiographic differentiation of osteogenic sarcoma, osteomyelitis, and fibrous dysplasia of the jaws.

UNLABELLED Biopsy and histopathologic analysis may fail to consistently separate osteogenic sarcoma, osteomyelitis, and fibrous dysplasia. OBJECTIVES To establish useful radiographic characteristics to differentiate these diseases, an objective preliminary study of radiographs of 30 cases of these diseases was done. STUDY DESIGN After precisely defining several radiographic characteristics and completing a calibration study, three observers unaware of the diagnosis examined study cases that were randomly ordered. RESULTS Despite using trained observers and strict criteria, differentiation of the three conditions is difficult on the basis of radiographic features alone. In osteogenic sarcoma, the distinguishing features were: permeative lesion borders, stippled bone pattern, destruction of cortical outlines, perpendicular spiculations of periosteal new bone, destruction of lamina dura, and widening of the entire periodontal ligament space. Presence of sequestra and laminations 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 and a fingerprint bone pattern were pathognomonic. Displacement of the maxillary sinus cortex, alteration of lamina dura to the abnormal bone pattern, and narrowing of the periodontal ligament space were also useful distinguishing features. CONCLUSIONS Our findings indicate that diagnosis cannot rely on radiographic characteristics alone, although some radiographic findings were more useful than others.