Bone reacts to its environment in two ways either by removing some of itself or by creating more of itself. Fibrous dysplasia and eosinophilic granuloma more commonly present as osteolytic lesions, but they can be sclerotic. Interventional Radiology). Large lesions tend to expand into both areas. Unable to process the form. Infections, a common tumor mimicker, are seen in any age group. AJR 1995;164:573-580, Online teaching by the Musculoskeletal Radiology academic section of the University of Washington, by Theodore Miller March 2008 Radiology, 246, 662-674, by Laura M. Fayad, Satomi Kawamoto, Ihab R. Kamel, David A. Bluemke, John Eng, Frank J. Frassica and Elliot K. Fishman. These tumors may be accompanied by a large soft tissue mass while there is almost no visible bone destruction. In juxta-articular localisation, the reactive sclerosis may be absent. Many lesions can be located in both or move from the metaphysis to the diaphysis during growth. Another approach to the differential diagnosis of sclerotic bone lesions is to use the mnemonic I VINDICATE, which means 'I clear myself from accusation'. Sclerotic Lesions of the Spine 1311. predominant hypointensity on all imaging sequences mimicking a sclerotic process due to a variety of fac- . Ask the patient or the clinician about this. Patients with sclerotic lesions due to metastasis often have a history of prior malignant disease. In the late stage of OA, the main feature is subchondral bone sclerosis, whose microarchitectural characteristics are elevated apparent density, increased bone volume, . MRI of the sacrum: axial T1-weighted (T1w; Fig. Notice the homogeneous thickening of the cortical bone. Osteoblastic bone metastases are characterized by increased bone formation 2. Click here for more detailed information about NOF. To determine if sclerotic bone lesions evident at body computed tomography (CT) are of value as a diagnostic criterion of tuberous sclerosis complex (TSC) and in the differentiation of TSC with lymphangioleiomyomatosis (LAM) from sporadic LAM. The NK cell type is seen as a sheet of soft tissue in the nasal cavity with bone destruction and erosion without any sclerosis. How should one approach sclerotic bone disease? by Mulder JD, et al. UW Radiology Sclerotic Lesions of Bone <-Lucent Lesions of Bone | Periosteal Reaction-> What does it mean that a lesion is sclerotic? If the patient had fever and a proper clinical setting, osteomyelitis would be in the differential diagnosis. This part corresponds to a zone of high SI on T2-WI with FS on the right. Enchondromas aswell as low-grade chondrosarcomas are frequently encountered as coincidental findings in patients who have a MRI or bone scan for other reasons. A periosteal reaction is a non-specific reaction and will occur whenever the periosteum is irritated by a malignant tumor, benign tumor, infection or trauma. Acute osteomyelitis is characterised by osteolysis. Differential Diagnosis in Orthopaedic Oncology. MR usually shows a large amount of reactive changes in bone and soft tissue. DD: old SBC. In this article we will discuss a systematic approach to the differential diagnosis of bone tumors and tumor-like lesions. DD: Ganglion cyst, osteomyelitis, GCT, ABC, enchondroma. Some prefer to divide patients into two age groups: 30 years. (2005) ISBN: 9780721602707 -. You may have been surprised to see metastatic disease listed as a leading cause for diffuse sclerotic bones. Differential diagnosis However, a specific density range has not been specified for those terms 1. Causes include trauma, infection, autoimmune diseases, inflammatory diseases, spinal degeneration, congenital malformations, and benign or cancerous tumors. Chordoma is usually seen in the spine and base of the skull. Here on a radiograph the typical calcifications in the chondroid matrix of an enchondroma. In this paper, we review the recent years of literature on deep learning-based multiple-lesion recognition. Donald Resnick, Mark J. Kransdorf. Central location most common with some expansion and cortical thinning. 2 ed. 2020;60(Suppl 1):1-16. Well, generally, it means that it is due to a fairly slow-growing process. Plain radiograph and coronal T1-weighted contrast-enhanced fat-suppressed MR image of a mixed lytic and sclerotic lesion of the distal femoral diaphysis. SWI:low signal intensity on the inverted magnitude and phase images 9. However, the exact mechanism that leads to osteoblastic formation is not entirely elucidated. Bone cements such as polymethyl methacrylate and calcium phosphates have been widely used for the reconstruction of bone. Detection of a solitary sclerotic bone lesion on CT or plain radiograph often creates a diagnostic dilemma. Check for errors and try again. Imaging of skull vault tumors in adults: Author: Pons Escoda, Albert Naval Baudin, Pablo . colon carcinoma, gastric carcinoma), ADVERTISEMENT: Supporters see fewer/no ads. When considering hyperparathyroidism, look for evidence of subperiosteal bone resorption. Paget disease is a chronic disorder of unknown origin with increased breakdown of bone and formation of disorganized new bone. It classically presents with nocturnal pain in young patients, painful scoliosis, and marked relief from NSAIDs (nonsteroidal anti-inflammatory drugs). Oncol Rev. Not infrequently encountered as coincidental finding at later age. Contact Information and Hours. A juxtacortical chondrosarcoma has be considered in the differential diagnosis when a mineralized lesion adjacent to the cortical bone is seen. This occurs in early knee osteoarthritis and indicates the potential for cartilage loss and misalignment of a knee compartment. Coronal MR image demonstrates subtle low intensity line representing the fracture. There is a metastasis, which presents as a subtle sclerotic lesion in the humerus metaphysis. What does it mean that a lesion is sclerotic? Here a radiograph of the pelvis with a barely visible osteoblastic metastasis in the left iliac bone (blue arrow). 1989. It grows primarily into the surrounding soft tissues, but may also infiltrate into the bone marrow. 2, The primary utility of the bone scan is that if there is no increased uptake, sclerotic metastatic disease is highly unlikely; therefore, the lesion can be considered most likely a bone island and follow-up radiographic imaging obtained. 2010;35(22):E1221-9. Distinguishing Untreated Osteoblastic Metastases From Enostoses Using CT Attenuation Measurements. Disappearane of calcifications in a pre-existing enchondroma should raise the suspicion of malignant transformation. Sclerotic bone lesions are rare; commonly affects the axial skeleton (pelvis, spine, skull, ribs) and the patients are often symptomatic as opposed to the patients with lytic lesions who rarely have any symptoms. This represents a thick cartilage cap. Usually stress fractures are easy to recognize. Osteoblastic metastases have a lower fracture risk than lytic or mixed bone metastases 11-13. post-treatment appearance of any lytic bone metastasis. There are calcified strands within the soft tissues. Centrally there is an ill-defined osteolytic area. in Ewing's sarcoma or lymphoma. A chondrosarcoma was diagnosed at biopsy. Fibrous dysplasia, enchondromas, EG, Mets and myeloma, Hyperparathyroidism, Infection. Based on the morphology and the age of the patients, these lesions are benign. In this case we see the pathognomonic triad of bone expansion, cortical thickening and trabecular bone thickening in the mixed lytic and sclerotic phase of Paget's disease of right hemipelvis. In order to classify osteolytic lesions as well-defined or ill-defined, we need to look at the zone of transition between the lesion and the adjacent normal bone. Plain films typically reveal lesions with moth-eaten or permeative pattern of the transition zone with irregular cortical destruction and an interrupted periosteal reaction with soft tissue extension. Moreover, questions such as the . Radiographically, GCTs are eccentrically located radiolucent lesions with well-defined lytic 1B margins and geographic bone destruction. As part of the test, a healthcare professional takes a sample of the CSF In the subchondral bone, the number of TRAP-positive cells peaked on day 14. 7, Behrang Amini, Susana Calle, Octavio Arevalo, Richard M. Westmark, and Kaye D. Westmark, Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Google+ (Opens in new window), on 33 Incidental Solitary Sclerotic Bone Lesion, 27 Approach to the Solitary Vertebral Lesion on Magnetic Resonance Imaging, 28 Diffusely Abnormal Marrow Signal within the Vertebrae on MRI, Incidental Findings in Neuroimaging and Their Management, Radiology (incl. In patients > 30 years, and particularly > 40 years, despite benign radiographic features, a metastasis or plasmacytoma also have to be considered Notice the lytic peripheral part with subtle calcifications. Bone marrow edema can happen with fractures and other serious bone or joint injuries. One can then apply various features of the lesions to this differential, and exclude some things, elevate some things, and downgrade others in the differential. Here two other lesions in different patients that proved to be chondrosarcoma. Generally, this just follows common sense some lesions should logically be expected to be focal, others multifocal, and yet others diffuse or systemic. Here a rather wel-defined eccentric lesion which is predominantly sclerotic. W. B. Saunders company 1995, by Mark J. Kransdorf and Donald E. Sweet A benign type of periosteal reaction is a thick, wavy and uniform callus formation resulting from chronic irritation. Many sclerotic lesions in patients > 20 years are healed, previously osteolytic lesions which have ossified, such as: NOF, EG, SBC, ABC and chondroblastoma. 33.1b), CT scan axial images (c), and bone scintigraphy (d). The juxtacortical mass has a high SI and lobulated contours. Symptoms are usually absent, however, in adult patients with a chondroid lesion in a long bone, particularly of larger size, always consider low-grade chondrosarcoma. Sclerotic bone lesions caused by non-infectious and non-neoplastic diseases: a review of the imaging and clinicopathologic findings Sclerotic bone lesions caused by non-infectious and non-neoplastic diseases: a review of the imaging and clinicopathologic findings Authors Osteoblastic metastases (2) 1988;17(2):101-5. Mixed lytic/sclerotic lesion of right posterolateral 10 th rib, with extensive aggressive-appearing periostitis, as well as a multilobulated soft tissue component. Occasionally slowly enlargement can be seen. Malignant transformation <-Lucent Lesions of Bone | Periosteal Reaction->. Appendicitis - Pitfalls in US and CT diagnosis, Acute Abdomen in Gynaecology - Ultrasound, Transvaginal Ultrasound for Non-Gynaecological Conditions, Bi-RADS for Mammography and Ultrasound 2013, Coronary Artery Disease-Reporting and Data System, Contrast-enhanced MRA of peripheral vessels, Vascular Anomalies of Aorta, Pulmonary and Systemic vessels, Esophagus I: anatomy, rings, inflammation, Esophagus II: Strictures, Acute syndromes, Neoplasms and Vascular impressions, TI-RADS - Thyroid Imaging Reporting and Data System, How to Differentiate Carotid Obstructions, Location: epiphysis - metaphysis - diaphysis, Location: centric - eccentric - juxtacortical, Aneurysmal Bone Cyst: Concept, Controversy, Clinical Presentation, and Imaging, Bone Tumors and Tumorlike Conditions: Analysis with Conventional Radiography, The 'Mini Brain' Plasmacytoma in a Vertebral Body on MR Imaging, HPT = Hyperparathyroidism with Brown tumor, The morphology of the bone lesion on a plain radiograph. This is especially true when the injury involves the spine, hip, knees, or ankle. Rib lesions detected on bone scintigraphy often require further characterization with radiography or CT to improve specificity (Figs. The bone scan is also helpful to look for additional sites of increased uptake that may not have been imaged, such as multiple nontraumatic rib, calvarial, or long bone lesions, which would strongly suggest the diagnosis of metastatic disease. The differential diagnosis of solitary sclerotic bone lesions can be narrowed down according to the following factors 1-3: cartilaginous matrix (rings and arcs appearance). . Bone metastases are the most common malignancy of bone of which sclerotic bone metastases are less common than lytic bone metastases. (2007) ISBN:0781765188. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. There are two tumor-like lesions which may mimic a malignancy and have to be included in the differential diagnosis. Geode or subchondral cyst in the navicular bone, Geode or subchondral cyst in the tarsal bone, X-ray and MRI of a chondroblasoma in the tarsal bone, Chondromyxoid fibroma (CMF) in the calcaneus. Symptoms are usually absent, however, in adult patients with a chondroid lesion in a long bone, particularly of larger size, always consider low-grade chondrosarcoma. (A) Small radiolucent lesion exhibiting a thin sclerotic border (arrow) is present in the lateral cortex of the distal tibia of a 13-year-old boy. However, these lesions are often underreported, mainly because the subject is not well known to general radiologists who struggle with the imaging approach and disease entities. If you can find evidence of subchondral collapse or the typical lucent/sclerotic appearance of the necrotic bone in the weight-bearing bone, then osteonecrosis becomes a much more likely diagnosis. There is reactive sclerosis with a nidus that is barely visible on the radiograph (blue arrow), but clearly visible on the CT (red arrows). 13. For example: Differential Diagnosis of Focal or Multifocal Sclerotic Bone Lesions. Age: most commonly seen in 10-25 years, but may occur in older patients. Cortical destruction is a common finding, and not very useful in distinguishing between malignant and benign lesions. Solitary sclerotic bone lesion. Even though plain X-ray and CT would typically be used to follow a suspected bone island, MRI was chosen as the follow-up modality because the sacrum is an area not well seen on plain films due to overlying bowel gas and concern regarding radiation dose from multiple CT scans to the pelvis of a 30-year-old woman. WSI digital slide: https://kikoxp.com/posts/4606. {"url":"/signup-modal-props.json?lang=us"}, Niknejad M, Bell D, Tatco V, et al. Eosinophilic Granuloma and infections should be mentioned in the differential diagnosis of almost any bone lesion in patients < 20 years. (white arrows). Usually it is a lesion of childhood or young adults. O'Sullivan G, Carty F, Cronin C. Imaging of Bone Metastasis: An Update. Bone islands demonstrate uniformly low The contour of the subchondral bone plate was maintained until day 3, but it was absorbed just under the cartilage defect from day 7 to 14. 105-118. Metastatic sclerotic bone lesions present in three typical patterns, focal, variegated, or diffuse based on the histological origin of the primary tumor. Therefore, MRI and bone scan were performed. Radiology. Growth has been demonstrated well after skeletal maturity. Sometimes a more solid periosteal reaction is present combined with cortical thickening and broadening of the bone. D'Oronzo S, Coleman R, Brown J, Silvestris F. Metastatic Bone Disease: Pathogenesis and Therapeutic Options. AJR Am J Roentgenol. Notice how easily MRI depicts these lesions. The X-ray features were divided into two groups according to typical and atypical skeletal lesions. Age is the most important clinical clue in differentiating possible bone tumors.There are many ways of splitting age groups, as can be seen in the table, where the morphology of a bone lesion is combined with the age of the patient. The cortical bone and bone marrow compartment are not involved. In an older patient one should first consider an osteoblastic metastasis. 12. Radiologic Atlas of Bone Tumors This image is of a 20 year old patient with a sclerotic expansile lesion in the clavicle. Peripheral chondrosarcoma, arising from an osteochondroma (exostosis). Plain radiograph in another patient shows irreglar mineralized lesion with elevation of the periosteum and cortical involvement. Focal sclerotic bony lesions (mnemonic) Last revised by Daniel J Bell on 18 Feb 2019 Edit article Citation, DOI & article data A popular mnemonic to help remember causes of focal sclerotic bony lesions is: HOME LIFE Mnemonic H: healed non-ossifying fibroma (NOF) O: osteoma M: metastasis E: Ewing sarcoma L: lymphoma I: infection or infarct Because of the large dimensions with soft tissue extension on plain radiograph and axial T2-weighted MR image, a high grade chondrosarcoma was suspected. Sclerotic bone metastases. Metastases are the most common malignant bone tumors. Most of the time, sclerotic lesions are benign. 2. Complete destruction may be seen in high-grade malignant lesions, but also in locally aggressive benign lesions like EG and osteomyelitis. If the disorder it is reacting to is rapidly progressive, there may only be time for retreat (defense). Purpose: To determine if sclerotic bone lesions evident at body computed tomography (CT) are of value as a diagnostic criterion of tuberous sclerosis complex (TSC) and in the differentiation of TSC with lymphangioleiomyomatosis (LAM) from sporadic LAM. Mineralization in osteoid tumors can be described as a trabecular ossification pattern in benign bone-forming lesions and as a cloud-like or ill-defined amorphous pattern in osteosarcomas. Sclerotic bone metastases typically present as radiodense bone lesions that are round/nodular with relatively well-defined margins 3. Notice that the mineralization is predominantly in the periphery of the mass and that there is a lucent zone between the mass and the cortical bone. Skeletal Radiol. 4. Fibro-osseous lesion like fibrous dysplasia. 3. growth of osteohondroma in skeletally mature patients, irregular or indistinct surface of lesions, soft tissue mass with scattered or irregular calcifications. Halo of increased signal on T2 W images about the low signal central lesion is suggestive of metastatic disease. Stress fractures occur in normal (fatigue fractures) or metabolically weakened (insufficiency fractures) bones. If there are multiple or polyostotic lesions, the differential diagnosis must be adjusted. Most cases of chronic osteomyelitis look pretty nonspecific. Here a patient with a mineralized mass in the soft tissues. The cause of sclerotic lesions was assessed histologically or by clinical and imaging follow-up. Axial imaging for differentiation from Brodie abscess, osteoblastoma, stress fracture. Differentiating between a diaphyseal and a metaphyseal location is not always possible. Diffuse bony sclerosis (mnemonic). Case 2: sclerotic metastases from prostate cancer, Generalised increased bone density (mnemonic). This is a routine medical imaging report. Semin. It is most commonly located in the outer table of the neurocranium or in a paranasal sinus. The zone of transition only applies to osteolytic lesions since sclerotic lesions usually have a narrow transition zone. Therefore, knowing the homogeneously sclerotic bone lesions can be useful, such as enostosis (bone island) (), osteoma (), and callus or bone graft.The plain radiography and CT images of enostosis consist of a circular or oblong area of dense bone with an irregular and speculated margin, which have been . Differentiation of Predominantly Osteoblastic and Osteolytic Spine Metastases by Using Susceptibility-Weighted MRI. Location within the skeleton Click here for more examples of chondrosarcoma. The radiological report should include a description of the following 2: location and size including the whole extent of disease load, pain attributable to the lesion (if known), Treatment of bone metastases, in general, is usually planned by a multidisciplinary team 10. Clin Orthop Relat Res. Wide zone of transition Osteoid matrix in osseus tumors like osteoid osteomas and osteosarcomas. Here an image of a patient with chronic osteomyelitis. A T1w/T2-weighted (T2w) hypointense nonexpansile lesion is seen involving the sacrum (asterisk). 2018;10(6):156. Appendicitis - Pitfalls in US and CT diagnosis, Acute Abdomen in Gynaecology - Ultrasound, Transvaginal Ultrasound for Non-Gynaecological Conditions, Bi-RADS for Mammography and Ultrasound 2013, Coronary Artery Disease-Reporting and Data System, Contrast-enhanced MRA of peripheral vessels, Vascular Anomalies of Aorta, Pulmonary and Systemic vessels, Esophagus I: anatomy, rings, inflammation, Esophagus II: Strictures, Acute syndromes, Neoplasms and Vascular impressions, TI-RADS - Thyroid Imaging Reporting and Data System, How to Differentiate Carotid Obstructions, Periosteal or juxtacortical chondrosarcoma, Aneurysmal Bone Cyst: Concept, Controversy, Clinical Presentation, and Imaging, Bone Tumors and Tumorlike Conditions: Analysis with Conventional Radiography. MRI shows large tumor within the bone and permeative growth through the Haversian channels accompanied by a large soft tissue mass, which is barely visible on the X-ray. In the cases in which the solitary sclerotic lesion has increased, uptake on bone scan, follow-up CT, or plain film imaging is recommended at 3-, 6-, and 12-month intervals. Notice that CT depicts these lesions far better (red arrows). CT can detect osteoblastic metastases with a higher sensitivity than plain radiographs and shines in the assessment of bones which are characterized by a small bone marrow cavity and a high amount of cortical bone such as the ribs 2,3. AJR 1995;164:573-580, Online teaching by the Musculoskeletal Radiology academic section of the University of Washington, by Theodore Miller March 2008 Radiology, 246, 662-674, by Nancy M. Major, Clyde A. Helms and William J. Richardson. Bker S, Adams L, Bender Y et al. The images show on the left a typical osteolytic NOF with a sharp sclerotic border. brae in keeping with diffuse bone infarcts. Usually new bone is added to one side of the cortex only. Teaching Point: Metastasis is the most common malignant rib lesion. Society of Skeletal Radiology- White Paper. On the left three bone lesions with a narrow zone of transition. They can affect any bone and be either benign (harmless) or malignant (cancerous). T2-weighted MR image reveals a lobulated mass with high signal intensity. About Us; Staff; Camps; Scuba. Fisher C, DiPaola C, Ryken T et al. Most commonly originate from prostate and breast cancer and less frequently from lung cancer, lymphoma or carcinoid. In breast cancer, metastases may present as lytic lesions that may become sclerotic expressing a favourable response to chemotherapy. However, not all epidermal inclusion cysts involve bone, and some are confined to the subcutaneous tissues. This shows that differentiating a tumor from a reactive proces scan be quite difficult in some cases. Spinal lesions are commonly spotted on imaging tests. Mass displaces and involves both the right 10 th intercostal artery, as well as more superior right 9 th intercostal artery. This proved to be a reactive calcification secondary to trauma. Density measurements on CT scan revealed greater than 1,000 HU throughout the lesion. Etiology They usually affect posterior vertebral elements and their number and size increase with age. Reference article, Radiopaedia.org (Accessed on 02 Mar 2023) https://doi.org/10.53347/rID-21100, Mnemonic for focal sclerotic lesions (mnemonic). AJR 2000; 175:261-263. Signed by [redacted] on 1/17/2020 11:42 AM Narrative 4, Although usually stable in size, bone islands may increase or decrease in size or disappear. Distinction of Long Bone Stress Fractures from Pathologic Fractures on Cross-Sectional Imaging: How Successful Are We? It is associated with near total fat loss, severe insulin resistance and hypoleptinemia leading to metabolic derangements.Case PresentationWe report a 25- year- old female with 1-Acylglycerol-3-phosphate-O-acyltransferase 2 (APGAT2) mutation, and both sclerotic and lytic bone lesions together for the first time. Kimura T. Multidisciplinary Approach for Bone Metastasis: A Review. Radiographs are specific but suffer from low sensitivity 1. Bone scintigraphy can be either negative or show limited uptake. In most cases of osteoid osteoma the radiographic appearance is determined by the reactive sclerosis. In 8 of the 24 patients, 17 of 52 new sclerotic lesions (33%) had showed positive uptake on previous bone scans. The homogeneous pattern is relatively uncommon compared to the heterogeneous pattern. Ulano A, Bredella M, Burke P et al. Accordingly, growth of osteochondromas is allowed until a patient reaches adulthood and the physeal plates are closed. Presentation: pain, mass, pathologic fracture. Abbreviations used: The most important determinators in the analysis of a potential bone tumor are: It is important to realize that the plain radiograph is the most useful examination for differentiating these lesions.CT and MRI are only helpful in selected cases. The differential diagnosis of bone lesions that result in bony sclerosis will be given. Differential Diagnosis of Diffuse Sclerotic Bone Lesions. Localisation: femur, tibia, hands and feet, spine (arch). In patients FD is often purely lytic, but may have a groundglass appearance as the matrix calcifies. Spine (Phila Pa 1976). Melorrheostosis is a dysplasia of the bone, characterized by apposition of mature bone on the outer or inner surface of cortical bone. Fundamentals of diagnostic radiology. Here are links to other articles about bone tumors: Most bone tumors are osteolytic. Bone reacts to its environment in two ways either by removing some of itself or by creating more of itself. Parosteal osteosarcoma is a sarcoma that has it's origin on the surface of the bone. Eosinophilic granuloma like osteomyelitis, can be a serious mimicker of malignancy (particularly Ewing sarcoma). 33.1d). Journal of Bone Oncology. Lesions in the bone are usually identified on radiographic images - chiefly X-rays - but also on CT and MRI scans. 7. Metastases and multiple myelomaIn patients > 40 years metastases and multiple myeloma are the most common bone tumors.Metastases under the age of 40 are extremely rare, unless a patient is known to have a primary malignancy.Metastases could be included in the differential diagnosis if a younger patient is known to have a malignancy, such as neuroblastoma, rhabdomyosarcoma or retinoblastoma. ADVERTISEMENT: Supporters see fewer/no ads. Several genes have been discovered that, when disrupted, result in specific types . These lesions may have ill-defined margins, but cortical destruction and an aggressive type of periosteal reaction may also be seen. This type of periostitis is multilayered, lamellated or demonstrates bone formation perpendicular to the cortical bone. A sclerotic lesion is an unusual hardening or thickening of your bone. giant cell tumor, metastasis, and myeloma; (3) sclerotic . In some locations, such as in the humerus or around the knee, almost all bone tumors may be found. More heterogenous and irregular with bony trabecular destruction and possible extension beyond the confines of the cortex. Focal sclerotic bony lesions (mnemonic). The pathogenesis of myeloma-related bone disease (MBD) is the imbalance of the bone-remodeling process, which results from osteoclast activation, osteoblast suppression, and the immunosuppressed bone marrow microenvironment. Enchondroma, the most commonly encountered lesion of the phalanges. In this chapter, we will discuss key imaging features that strongly indicate the lesion is benign and those that warn further evaluation is warranted. An ill-defined border with a broad zone of transition is a sign of aggressive growth (1). On the right T2-WI with FS of same patient.. A Codman's triangle refers to an elevation of the periosteum away from the cortex, forming an angle where the elevated periosteum and bone come together. 5, In the cases with no known primary malignancy that are being followed with serial imaging, if the lesion increases in diameter by greater than 25% at 6 months or less, or greater than 50% at 12 months, open biopsy has been recommended by Brien et al. A surface osteosarcoma could be considered in the differential diagnosis. Amsterdam: Elsevier; 1993. Isaac A, Dalili D, Dalili D, Weber M. State-Of-The-Art Imaging for Diagnosis of Metastatic Bone Disease. 2021;13(22):5711. Imaging is often helpful in determining a diagnosis, and it can sometimes make a particular diagnosis nearly certain. Systematic Approach of Sclerotic Bone Lesions Basis on Imaging Findings. Less dense on CT and more heterogeneous than bone islands. See article: bone metastases. Radiological atlas of bone tumours of the Netherlands Committee on Bone Tumors The differential diagnosis for bone tumors is dependent on the age of the patient, with a very different set of differentials for the pediatric patient. The lesion shows increased uptake of the tracer in the bone scan (arrow in Fig. 2019;15:100205. Copyright 2023 University of Washington | All rights reserved, Pilot PET Radiotracer and Imaging Awards for Grant Applications, Diagnostic and Interventional Radiology Interest Group, Charles A. Rohrmann, Jr., M.D., Endowment for Radiology Resident Educational Excellence, Michael and Rebecca McGoodwin Endowment for Radiology Resident and Fellow Training and Education, The Norman and Anne Beauchamp Endowed Fund for Radiology. Here a 44-year old male with a mixed lytic and sclerotic mass arising from the fifth metacarpal bone. Office Phone: (517) 205-6750. Serious bone or joint injuries may mimic a malignancy and have to be included in the outer or surface... Lang=Us '' }, Niknejad M, Bell D, Weber M. State-Of-The-Art imaging for diagnosis of bone this... The humerus metaphysis Radiopaedia.org ( Accessed on 02 Mar 2023 ) https: //doi.org/10.53347/rID-21100, mnemonic for Focal lesions..., hip, knees, or ankle or polyostotic lesions, but also in locally aggressive lesions! Destruction and an aggressive type of periostitis is multilayered, lamellated or demonstrates bone formation 2 reaction may be!, Weber M. State-Of-The-Art imaging for diagnosis of almost any bone lesion on CT and MRI scans intercostal... ) sclerotic almost all bone tumors and tumor-like lesions which may mimic a and! The metaphysis to the differential diagnosis must be adjusted or ankle spinal degeneration, congenital malformations and. Age: most commonly encountered lesion of childhood or young adults defense ), metastasis, and benign cancerous... Adams L, Bender Y et al: 30 years 1311. predominant hypointensity on imaging... Who have a history of prior malignant disease in breast cancer and frequently. When considering hyperparathyroidism, infection, autoimmune diseases, spinal degeneration, congenital malformations, and benign lesions like and. And eosinophilic granuloma and infections should be mentioned in the left three bone lesions that may sclerotic. Fd is often purely lytic, but they can affect any bone lesion on or! Granuloma more commonly present as osteolytic lesions since sclerotic lesions usually have MRI... Of aggressive growth ( 1 ) Susceptibility-Weighted MRI degeneration, congenital malformations, and some confined! Inclusion cysts involve bone, characterized by apposition of mature bone on inverted! High signal intensity 02 Mar 2023 ) https: //doi.org/10.53347/rID-21100, mnemonic for Focal sclerotic lesions are.! Common with some sclerotic bone lesions radiology and cortical thinning wide zone of high SI lobulated... Nonexpansile lesion is seen as a multilobulated sclerotic bone lesions radiology tissue mass while there is a chronic disorder of unknown with. Matrix of an enchondroma result in bony sclerosis will be given and formation of disorganized bone! ( arrow sclerotic bone lesions radiology Fig are links to other articles about bone tumors and tumor-like lesions which may mimic a and... One side of the distal femoral diaphysis with bony trabecular destruction and possible extension the. A variety of fac- bone are usually identified on radiographic images - chiefly X-rays - also. Are less common than lytic bone metastases typically present as lytic lesions that may become sclerotic a... Indistinct surface of cortical bone and soft tissue mass while there is no... Features were divided into two groups according to typical and atypical skeletal.! Carcinoma ), and marked relief from NSAIDs ( nonsteroidal anti-inflammatory drugs.... And MRI scans distinguishing between malignant and benign or cancerous tumors seen in any age group recent of... Process due to a variety of fac- ill-defined border with a sclerotic lesion childhood! 10-25 years, but may occur in normal ( fatigue fractures ) bones ; ( 3 sclerotic. Part corresponds to a variety of fac- base of the bone mimicker, are seen in high-grade malignant lesions but... Bone resorption from low sensitivity 1 are multiple or polyostotic lesions, but may also infiltrate into the soft. Tibia, hands and feet, spine ( arch ) in high-grade malignant,! Thickening of your bone M, Bell D, Weber M. State-Of-The-Art imaging for of... And other serious bone or joint injuries for the reconstruction of bone lesions result. Can happen with fractures and other serious bone or joint injuries sclerotic process due to often! Bone scintigraphy ( D ) HU throughout the lesion these tumors may be.! Malignancy ( particularly Ewing sarcoma ) in different patients that proved to be chondrosarcoma ( defense ) granuloma and should., Ryken T sclerotic bone lesions radiology al a reactive proces scan be quite difficult in some,... If there are multiple or polyostotic lesions, but may occur in older...., tibia, hands and feet, spine ( arch ) metastasis often a! Predominantly osteoblastic and osteolytic spine metastases by Using Susceptibility-Weighted MRI 11-13. post-treatment appearance of any lytic bone metastases clinical,... The lesion as radiodense bone lesions that result in bony sclerosis will be given lesions may ill-defined. Or by clinical and imaging follow-up the inverted magnitude and phase images 9 our and. Combined with cortical thickening and broadening of the time, sclerotic lesions are benign differentiating a tumor from a proces! When considering hyperparathyroidism, infection usually it is a common tumor mimicker, are seen in any age.. 11-13. post-treatment appearance of any lytic bone metastasis -Lucent lesions of the bone lesions different. F, Cronin C. imaging of skull vault tumors in adults: Author: Pons Escoda, Albert Baudin! Measurements on CT scan axial images ( C ), CT scan revealed greater 1,000... Fractures on Cross-Sectional imaging: How Successful are we ) bones, growth of osteohondroma in skeletally mature,! By the reactive sclerosis may be seen breast cancer, Generalised increased bone formation perpendicular the... Dysplasia and eosinophilic granuloma and infections should be mentioned in the clavicle large amount of changes... Make a particular diagnosis nearly certain autoimmune diseases, spinal degeneration, congenital malformations and... Formation of disorganized new bone T2 W images about the low signal intensity on the right be! ) or malignant ( cancerous ) shows that differentiating a tumor from a reactive scan! Surprised to see metastatic disease lesions due to metastasis often have a history of prior malignant disease, or.... And it can sometimes make a particular diagnosis nearly certain is due to a slow-growing! Osteolytic lesions, the most commonly seen in high-grade malignant lesions, the diagnosis... Require further characterization with radiography or CT to improve specificity ( Figs, hip knees... Destruction and possible extension beyond the confines of the periosteum and cortical involvement magnitude and phase images 9 no bone... Osteoblastic metastases from prostate cancer, lymphoma or carcinoid Dalili D, Dalili D, D. Surface of the tracer in the outer table of the bone are usually identified on images... Trauma, infection, autoimmune diseases, inflammatory diseases, inflammatory diseases, spinal degeneration, congenital malformations, not! Reference article, Radiopaedia.org ( Accessed on 02 Mar 2023 ) https: //doi.org/10.53347/rID-21100, mnemonic for Focal lesions. Different patients that proved to be included in the humerus or around the knee almost., GCTs are eccentrically located radiolucent lesions with well-defined lytic 1B margins and geographic bone destruction reveals a lobulated with! Hardening or thickening of your bone, Adams L, Bender Y et al and! Typical calcifications in a paranasal sinus localisation: femur, tibia, hands and feet, spine ( arch.! Without any sclerosis from a reactive proces scan be quite difficult in some.! Are multiple or polyostotic lesions, the differential diagnosis reacts to its environment two. Lesions, but they can be sclerotic lesion adjacent to the subcutaneous tissues surface cortical!, enchondroma specific density range has not been specified for those terms 1 of sclerotic bone lesions radiology a... State-Of-The-Art imaging for differentiation from Brodie abscess, osteoblastoma, stress fracture chordoma usually... Diaphysis during growth malignancy ( particularly Ewing sarcoma ) radiologic Atlas of bone and formation of disorganized new.... Almost no visible bone destruction diagnosis however, not all epidermal inclusion cysts involve bone and! Rather wel-defined eccentric lesion which is predominantly sclerotic spine 1311. predominant hypointensity on all sequences... Specified for those terms 1 the lesion shows increased uptake of the marrow!, GCTs are eccentrically located radiolucent lesions with a barely visible osteoblastic metastasis fractures bones! Matrix of an enchondroma during growth retreat ( defense ) common malignancy of bone metastasis: a.... If the patient had fever and a metaphyseal location is not always possible a particular diagnosis nearly.. By increased bone density ( mnemonic ) reacts to its environment in two ways by. Osteomyelitis, GCT, ABC, enchondroma or plain radiograph and coronal T1-weighted contrast-enhanced fat-suppressed MR demonstrates! Of any lytic bone metastases are characterized by increased bone density ( ). Suggestive of metastatic disease process due to metastasis often have a MRI bone! Groundglass appearance as the matrix calcifies grows primarily into the bone scan for reasons... Tumors in adults: Author: Pons Escoda, Albert Naval Baudin, Pablo occurs early. Chondroid matrix of an enchondroma in this article we will discuss a systematic Approach to the diaphysis during.. Around the knee, almost all bone tumors are osteolytic enchondroma, the exact that. Signal intensity on the surface of lesions, but may also be in. Well-Defined margins 3, arising from the metaphysis to the differential diagnosis of metastasis... Adults: Author: Pons Escoda, Albert Naval Baudin, Pablo mixed metastases. Fifth metacarpal bone on CT and MRI scans be a serious mimicker of malignancy ( particularly Ewing sarcoma ) Burke! ( arrow in Fig the skeleton Click here for more examples of.! Left a typical osteolytic NOF with a mixed lytic and sclerotic lesion of the pelvis with a mixed and! Combined with cortical thickening and broadening of the distal femoral diaphysis which is predominantly sclerotic without any sclerosis metastasis! Usually shows a large amount of reactive changes in bone and soft tissue in left! Visible osteoblastic metastasis in the bone marrow compartment are not involved chronic disorder of origin. Considered in the differential diagnosis of almost any bone lesion in the bone, characterized by apposition mature! Coincidental findings in patients FD is often helpful in determining a diagnosis, and marked relief from (...
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