Imaging appearance of bone tumors of the maxillofacial region

Table 1 World Health Organization classification of benign and malignant bone tumors of the maxillofacial region[1]

	Benign	Malignant
Osteogenic	Osteoma	Osteosarcoma
	Osteoid osteoma
	Osteoblastoma
Chondrogenic	Chondroblastoma	Chondrosarcoma
	Chondromyxoid fibroma
	Chondroma
	Osteochondroma
Fibrogenic	Fibrous dysplasia	Fibrosarcoma
Vascular	Hemangioma	Hemangioendothelioma
Hematopoietic	-	Plasmacytoma
		Lymphoma
Others	Giant cell tumor	Chordoma
	Aneurysmal bone cyst	Ewing sarcoma
	Meningioma

Table 2 Computed tomography and magnetic resonance imaging appearance of bone tumors of the maxillofacial region

	Incidence	Computed tomography	Magnetic resonance imaging
Osteoma	5th-6th decade	Compact: dense sclerotic	Compact: signal void
		Cancellous: mixed densities	Cancellous: low to absent signal
		Sharp, well defined lesion attached by a broad base or pedicle to the bone
Osteoid osteoma	2nd-3rd decade	Radio lucent nidus (< 1.5 cm) surrounded by dense sclerosis	Non specific signal intensity with patchy enhancement
Osteoblastoma	2nd decade	Expansile lesion with cortical shell	Non specific signal intensity
		May mixed or sclerotic lesion
Chondroblastoma	More than 30 yr	Lytic lesion with central calcifications and peripheral thin cortical shell	Signal void regions of calcification
Chondromyxoid fibroma	2nd-3rd decade	Well-demarcated expansile lesion with multiple foci of calcification	Signal void regions of calcification
Chondroma	Less than 50 yr	Small polypoid mass with few discrete areas of calcifications	Non specific appearance
Osteochondroma	2nd-4th decade	Mushroom shaped bony outgrowth with calcified cartilagenous cap	Hypointense bony outgrowth with hyperintense cartilaginous cap
Fibrous dysplasia	1st-2nd decade	Ground glass appearance (56%), sclerotic (23%)	Variable signal intensity depends upon amount of fibrous and sclerotic regions
		Lytic with sclerotic margins (21%)
Giant cell tumor	3rd-4th decade	Expansile mass that tends to destroy and remodel the adjacent bone	Low signal on all sequences
Aneurysmal bone cyst	2nd decade	Lytic expansile lesion with multi-locular "soap bubble" (honey comb) and may fluid–fluid levels	Fluid fluid level with septal enhancement
Hemangioma	2nd decade	Sunburst or spoke wheel pattern of radiating trabeculae	Stippled appearance with intense enhancement
Meningioma	4th decade	Osteoblastic or mixed sclerotic lesion	Low signal on all sequences with intense enhancement
Osteosarcoma	3rd decade	Commonly sclerotic lesion with calcified matrix and sunburst periosteal reaction or it may be mixed or lytic lesion	Signal void of calcification and new bone formation with heterogeneous contrast enhancement
Chondrosarcoma	4th-5th decade	Bony destructive lesion with multiple punctate and stippled calcifications	T2WI: hyperintense areas (chondroid) and hypointense areas (calcified). Curvilinear enhancement
Ewing sarcoma	1st-2nd decade	Destructive aggressive mass with mottled lucent areas and sclerosis and onion peal periosteal reaction	Non specific signal intensity with inhomogeneous enhancement
Fibrosarcoma	3rd-6th decade	Destructive bony lesion, frequently associated with extra osseous soft tissue mass	Low to intermediate signal intensity with inhomogeneous enhancement
Hemangio-endothelioma	2nd decade	Multifocal lytic lesion or dense sclerotic lesion	Tubular signal void structures with intense enhancement
Chordoma	4th decade	Hypodense mass with irregular intratumoral calcifications (30%-50%) with bone destruction	Mixed signal intensity with inhomogeneous enhancement
Lymphoma	4th-7th decade	Lytic, sclerotic or mixed lesions that may be associated with soft tissue mass	Non specific magnetic resonance imaging appearance
Plasmacytoma	4th-7th decade	Well defined bony expansile lesion with intense enhancement	Low SI on T1-weighted images, high on T2-weighted images with intense enhancement
Metastasis	All ages	Radiolucent lesion with cortical destruction. May sclerotic or mixed lytic and sclerotic	Non specific magnetic resonance imaging appearance

SI: Signal intensity