The image shows a calcified lesion in the proximal tibia without suspicious features. Here a 44-year old male with a mixed lytic and sclerotic mass arising from the fifth metacarpal bone. Imaging of skull vault tumors in adults: Author: Pons Escoda, Albert Naval Baudin, Pablo . Osteoblastic bone metastases are characterized by increased bone formation 2. Subchondral bone attrition is the flattening or depression of the bone surface that forms part of a joint. More uniform cortical bone destruction can be found in benign and low-grade malignant lesions. Cortical destruction (3) The zone of transition only applies to osteolytic lesions since sclerotic lesions usually have a narrow transition zone. The sagittal T1WI and Gd-enhanced T1W-image with fatsat show a large tumor mass infiltrating a large portion of the distal femur and extending through the cortex into the soft tissues. Polyostotic lesions It can differentiate predominantly osteoblastic from osteolytic bone metastases 9 as well as easily demonstrate and assess complications such as pathological fractures or spinal cord compression 2,3. Enchondroma is a fairly common benign cartilaginaous lesion which may present as an entirely lytic lesion without any calcification, as a dense calcified lesion or as a mixed leson with osteolysis and calcifications. 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. Causes: corticosteroid use, sickle cell disease, trauma, Gaucher's disease, renal transplantation. The signal intensity on MR depends on the amount of calcifications and ossifications and fibrous tissue (low SI) and cystic components (high SI on T2). One of the first things you should notice about sclerotic bone lesions is whether they are single and focal, multifocal, or diffuse. Case 2: sclerotic metastases from prostate cancer, Generalised increased bone density (mnemonic). ADVERTISEMENT: Supporters see fewer/no ads. 2. The term bone infarction is used for osteonecrosis within the diaphysis or metaphysis. In the late stage of OA, the main feature is subchondral bone sclerosis, whose microarchitectural characteristics are elevated apparent density, increased bone volume, . 2018;2018:1-5. If the lesion grows more rapidly still, there may not be time for the bone to retreat in an orderly manner, and the margin may become ill-defined. Here a lesion located in the epi- and metaphysis of the proximal humerus. J Korean Soc Radiol. 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. Most primary bone tumors are seen in patients In patients > 30 years we must always include metastases and myeloma in the differential diagnosis. The most common appearance is the mixed lytic-sclerotic. 1, The classic bone island has a spiculated or paintbrush border and is much denser on CT than a osteoblastic metastasis. Radiographs are specific but suffer from low sensitivity 1. There is a metastasis, which presents as a subtle sclerotic lesion in the humerus metaphysis. Sclerotic jaw lesions are not rare and are frequently encountered on radiographs and computed tomography (CT). Once we have decided whether a bone lesion is sclerotic or osteolytic and whether it has a well-defined or ill-defined margins, the next question should be: how old is the patient? There is no calcification and lesions may be expansile. At Henry Ford Orthopaedics in Chelsea our mission is to provide personalized treatment plans specific to each patient, to ensure the best possible outcome. Both imaging modalities achieved only a moderate correlation with DEXA. Bone cements such as polymethyl methacrylate and calcium phosphates have been widely used for the reconstruction of bone. 1991;167(9):549-52. 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. Not infrequently encountered as coincidental finding at later age. Growth has been demonstrated well after skeletal maturity. A molecular classification has been also proposed. After an injury, different types of fluid can build up in a bone. It can also be proven histologically. In the group of malignant small round cell tumors which include Ewing's sarcoma, bone lymphoma and small cell osteosarcoma, the cortex may appear almost normal radiographically, while there is permeative growth throughout the Haversian channels. Differential Diagnosis of Diffuse Sclerotic Bone Lesions. Here images of a patient with prostate cancer. Signed by [redacted] on 1/17/2020 11:42 AM Narrative Coronal MR image demonstrates subtle low intensity line representing the fracture. Rib metastases may be osteolytic, sclerotic, or mixed. 2015;7(8):202-11. If the patient had fever and a proper clinical setting, osteomyelitis would be in the differential diagnosis. In fact, in areas where sickle cell disease is common, this may be the leading cause of diffuse sclerotic bones. Amsterdam: Elsevier; 1993. Occasionally slowly enlargement can be seen. 33.1b), CT scan axial images (c), and bone scintigraphy (d). It is a feature of malignant bone tumors. FIGURE 2.7 Computed tomography of osteoid osteoma. 4 , 5 , 6. Here an illustration of the most common sclerotic bone tumors. Fundamentals of Skeletal Radiology, second edition Many lesions can be located in both or move from the metaphysis to the diaphysis during growth. Particularly chronic osteomyelitis may have a sclerotic appearance. Check for errors and try again. Bone marrow edema can happen with fractures and other serious bone or joint injuries. A surface osteosarcoma could be considered in the differential diagnosis. T2-weighted MR image reveals a lobulated mass with high signal intensity. Diffuse bony sclerosis (mnemonic). Notice the lytic peripheral part with subtle calcifications. Check for errors and try again. some benign entities in this region may mimic malignancy if analyzed using classical bone-tumor criteria, and proper patient management requires being familiar with these presentations. Well, generally, it means that it is due to a fairly slow-growing process. Here some typical examples of bone tumors in the spine. CT Cancers (Basel). Eosinophilic Granuloma and infections should be mentioned in the differential diagnosis of almost any bone lesion in patients < 20 years. Small area of lucency with adjacent sclerosis at the distal right medial femoral metaphysis that could relate to enthesopathic change or remodeling of a fibroxanthoma of bone.. 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. Recommendation: No specific imaging recommendation. 2017;11(1):321. When you are considering osteonecrosis in your differential diagnosis, look at the joints carefully. This solitary, uniformly high-density lesion with neither edema in the surrounding bone marrow nor extension into the surrounding soft tissue most likely represents a giant bone island. Gadolinium is usually minimal or absent (see right image). 13. 9. Reference article, Radiopaedia.org (Accessed on 02 Mar 2023) https://doi.org/10.53347/rID-21100, Mnemonic for focal sclerotic lesions (mnemonic). Plain radiograph in another patient shows irreglar mineralized lesion with elevation of the periosteum and cortical involvement. Notice the homogeneous thickening of the cortical bone. Most commonly originate from prostate and breast cancer and less frequently from lung cancer, lymphoma or carcinoid. The homogeneous pattern is relatively uncommon compared to the heterogeneous pattern. Multiple myeloma is a hematologic malignancy of plasma cells that causes bone-destructive lesions and associated skeletal-related events (SREs). Notice that many benign osteolytic lesions that are frequently seen in younger age groups may heal and appear as sclerotic lesions in the middle aged group. W. B. Saunders company 1995, by Mark J. Kransdorf and Donald E. Sweet In some locations, such as in the humerus or around the knee, almost all bone tumors may be found. Coronal T1W image shows lobulated margins and peripheral low SI due to the calcifications. There are calcified strands within the soft tissues. The diagnosis was fibrous dysplasia. CT scan is usually very helpful in detecting the nidus and differentiating osteoid osteoma from other sclerotic lesions like osteoblastoma, osteomyelitis, arthritis, stress fracture and enostosis. 5 Biopsy should be considered in atypical cases or in high-risk patients with primary malignancies associated with osteoblastic metastatic disease. 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. Metastases are the most common malignant bone tumors. The lesion is predominantly calcified. If there are multiple or polyostotic lesions, the differential diagnosis must be adjusted. Density measurements on CT scan revealed greater than 1,000 HU throughout the lesion. Solitary sclerotic bone (osteosclerotic or osteoblastic) lesions are lesions of bone characterized by a higher density or attenuation on radiographs or computer tomography compared to the adjacent trabecular bone. Regarding bone disease in SM, increased sBT levels have been 493 associated with both bone sclerosis (due to unknown mechanisms) (8, 18, 19) and 494 osteoporosis (it has been hypothesized that tryptase could induce the production of 495 OPG (61)) (4, 17). At the periphery of the infarct a zone of relative high signal intensity on T2WI may be found. Typical bone metastases are osteolytic (87.5%), with medullary origin (91.6%), and they cannot be distinguished from other osteolytic metastases on the basis of imaging criteria alone. Azar A, Garner H, Rhodes N, Yarlagadda B, Wessell D. CT Attenuation Values Do Not Reliably Distinguish Benign Sclerotic Lesions From Osteoblastic Metastases in Patients Undergoing Bone Biopsy. Paget disease is a chronic disorder of unknown origin with increased breakdown of bone and formation of disorganized new bone. Differentiation of Predominantly Osteoblastic and Osteolytic Spine Metastases by Using Susceptibility-Weighted MRI. Frequently encountered as a coincidental finding and can be found in any bone. Chordoma is usually seen in the spine and base of the skull. The location of a bone lesion within the skeleton can be a clue in the differential diagnosis. MRI features high sensitivity and high specificity for the demonstration of bone metastases in general and for assessing the bone marrow 2,3. A periosteal reaction with or without layering may be present. 2 ed. 2022;51(9):1743-64. Large lesions tend to expand into both areas. 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