Archives of the AFIP -- RadioGraphics 1997; 17: 1205-1231

Figure 15: Periosteal osteosarcoma of the femoral diaphysis in a 14-year-old boy. (a-c) Anteroposterior radiograph (Panel A), coronal T1-weighted MR image (Panel B), and photograph of the sagittally sectioned gross specimen (Panel C) show cortical periosteal reaction (Codman triangle, curved arrows) and cortical thickening (open arrows). The cortex is scalloped with hair-on-end periosteal reaction (small arrowheads) extending into a broad-based soft-tissue mass (large arrowheads). (Panel D) Bone scan reveals similar findings, with increased radionuclide uptake seen along the juxtacortical lesion. (Panel E, Panel F) Axial CT scan (e) and axial T2-weighted MR image (f) show perpendicular periosteal reaction (arrowheads) and chondroblastic nonmineralized component (arrows) as low attenuation and very high signal intensity, respectively. On the T1-weighted MR image (b), the small areas of low signal intensity in the marrow space (solid arrows) are separated from the juxtacortical mass and represent reactive changes and not marrow invasion. This finding was proved pathologically, as shown by lack of marrow involvement (*) in the gross specimen (c).

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