Describing Radiographic Lesions

Describing radiographic lesions can be a tricky thing at first, but with practice and lots of radiographic examples it starts to become second nature.  I created the acronym below for my students when teaching them how to describe radiographic lesions.  The entire acronym applies to intraosseous (within bone) lesions.  Not all the letters/topics apply to all radiographic lesions.  So take a look and try it out.  I’ve included a short video if you prefer that format. If you have any questions, please let me know.  Thanks and enjoy!

L – Location

E – Edge

S – Shape

I – Internal

O – Other Structures

N – Number

(S) – Size (extra information if you should want it and have digital imaging)

L – Location

 Position in the Jaws

A)     Identify the location in the jaws (ie – maxilla versus mandible and anterior versus posterior, be as specific as you can).

 E – Edge

Edge

A)     Identify whether the edge of the abnormality is well-defined, ill-defined or well-localized.

1. A well-defined entity has a sharp edge that allows the entire edge of the lesion to be traced.  The surrounding bone of a well-defined lesion appears normal up to the edge of the abnormality.   Some well-defined borders have a radiopaque (bony) border and are classified as corticated.  A corticated border can range from thin to thick.
2. An ill-defined entity is a gradual transition between normal appearing bone and the abnormal bone of the lesion.  The border of the lesion cannot be traced and the edges of the lesion are not clear.
3. A well-localized entity is visible in a specific area but the edges may not be clearly identified around the entire lesion.

S – Shape

Shape

A)     Identify the general shape of the abnormality. Common shapes include circular, ovoid, linear or scalloped. (Not all lesions have an identifiable shape so don’t try to force it too hard if nothing obvious pops into your head)

 I – Internal structure

Radiolucent

A)     Identify if the entire internal aspect of the abnormality is completely radiolucent.  Further classification includes unilocular versus multilocular.

1. Unilocular is completely radiolucent.
2. Multilocular has bony septum within the entity.

Radiopaque

A)     Identify if the entire internal aspect of the abnormality is completely radiopaque.

B)      Determine the radiopacity of the internal aspect. For example – similar radiopacity to tooth structure, bone, etc.

Mixed Radiolucent/Radiopaque

A)     Identify if the internal aspect is a mixture of radiolucent and radiopaque areas.

O – Other structures

Teeth

A)     Identify if the adjacent teeth are being displaced or resorbed. Evaluate which direction the teeth are displaced. Evaluate where the resorption is occurring – ie midroot or apex.

  Inferior Alveolar Nerve Canal (Mandibular Canal)

A)     Identify any changes to the course of the canal. Note if the canal is being displaced inferiorly or superiorly.

B)      Identify if there are changes to the size of the canal. Is it being enlarged or smaller than what is within the range of normal.

  Cortical Bone

A)     Identify any changes in the thickness of the cortical bone. Is there thinning of the cortical bone in the area of the abnormality?

B)      Identify any changes in the location of the cortical bone. Is the cortical bone being displaced inferiorly, superiorly, lingually or facially?

 N – Number

Single of Multiple

A)     If there is one abnormality, it is a single entity.

B)      If there is more than one site throughout the jaws, it is multiple.

For more information and diagrams, please visit these posts from my blog

Location

Edge

Shape

Internal

Other structures

Number