Sunburst Pattern

One of the earliest and most eloquent descriptions of the characteristic periosteal reaction seen with osteosarcomas was that of Frederick Baetjer ¹ (Johns Hopkins University). In the 1921 textbook, he wrote with Charles Waters, he referred to the radiating spicules of periosteal sarcoma as ‘resembling the rays of the sunset’ and those of central osteosarcoma ‘like church spires piercing a city’s sky line’ ¹ (Figure 1). For osteosarcomas, this sunray pattern has been transformed, in today’s terminology, into a sunburst. This is perhaps more in keeping with the aggressive (malignant) growth indicated by this sign. The sunray terminology is still used, more appropriately in this author’s opinion, for the appearance of a benign lesion, a hemangioma in the skull. Many other authors used the radiating spicule and ray terminology before Baetjer and certainly influenced him ² . Figure 1 Osteosarcoma with ‘Lumps, clouds and consolidated rays of tumor bone in the upper half of the extraosseous mass.’ Reprinted with permission from <italic>The Rones and Joints</italic> by Lodwick (1971)<xref ref-type="bibr" rid="ref86_5"> ⁵ </xref>. published by Year Book Medical Publishers, Chicago. Copyright 1971 by the ACR https://s3-euw1-ap-pe-df-pch-content-public-p.s3.eu-west-1.amazonaws.com/9781003076568/34c29fd5-5662-4e8f-b58c-badd7fa5d724/content/fig86_1_B.jpg"/>