Generic Differential Diagnosis of Sclerotic Bone Lesions. When a reactive process is more likely based on history and imaging features, follow-up is sometimes still needed. Sclerotic bone metastases can arise from several different primary malignancies including 1-3: mucinous adenocarcinoma of the gastrointestinal tract (e.g. Another approach to the differential diagnosis of sclerotic bone lesions is to use the mnemonic I VINDICATE, which means 'I clear myself from accusation'. 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.. The term bone infarction is used for osteonecrosis within the diaphysis or metaphysis. In some cases however the osteolytic nidus can be visible on the radiograph (figure). Sclerotic means that the lesions are slow-growing changes to your bone that happen very gradually over time. Check for errors and try again. Case 7: metastases from prostate carcinoma, Sclerotic bone pseudolesions - external artifact, bizarre parosteal osteochondromatous proliferation (Nora lesion), conventional intramedullary chondrosarcoma, dysplasia epiphysealis hemimelica (Trevor disease), solitary bone plasmacytoma with minimal bone marrow involvement, mixed lytic and sclerotic bone metastases, Lodwick classification of lytic bone lesions, Modified Lodwick-Madewell classification of lytic bone lesions. Mild mass effect on adjacent lung, diaphragm, and liver. Sclerotic bone metastases. 1. Giant cell bone tumors are usually benign (not cancerous) but the malignant form can affect the legs, especially near the knees. BallooningBallooning is a special type of cortical destruction.In ballooning the destruction of endosteal cortical bone and the addition of new bone on the outside occur at the same rate, resulting in expansion. Osteoid osteoma (2) However, a specific density range has not been specified for those terms 1. FIGURE 2.7 Computed tomography of osteoid osteoma. Impact of Sclerotic. (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. Gadolinium is usually minimal or absent (see right image). Causes include trauma, infection, autoimmune diseases, inflammatory diseases, spinal degeneration, congenital malformations, and benign or cancerous tumors. Resonance Imaging Saeed M. Bafaraj . There are two tumor-like lesions which may mimic a malignancy and have to be included in the differential diagnosis. 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. Differentiation of Predominantly Osteoblastic and Osteolytic Spine Metastases by Using Susceptibility-Weighted MRI. The chondroid matrix is of a variable amount from almost absent to dens compact chondroid matrix. Axial T1-weighted MR image shows homogeneous low signal intensity due to the compact bone apposition. 2nd most common primary bone tumor and highly malignant. 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. Metastases must be included in the differential diagnosis of any bone lesion, whether well-defined or ill-defined osteolytic or sclerotic in age > 40. Click here for more examples of eosinophilic granuloma. 33.1b), CT scan axial images (c), and bone scintigraphy (d). 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. The mnemonic I VINDICATE is a commonly used mnemonic for the differential diagnostis of any radiological lesion. Therefore, MRI and bone scan were performed. MRI features high sensitivity and high specificity for the demonstration of bone metastases in general and for assessing the bone marrow 2,3. Osteoblastic metastases have a lower fracture risk than lytic or mixed bone metastases 11-13. post-treatment appearance of any lytic bone metastasis. Many sclerotic lesions in patients > 20 years are healed, previously osteolytic lesions which have ossified, such as: NOF, EG, SBC, ABC and chondroblastoma. Recommendation: No specific imaging recommendation. Clinically relevant bone metastases are a major cause of morbidity and mortality for prostate cancer patients. Contact Information and Hours. Consider progression of osteohondroma to chondrosarcoma when cartilage cap measures > 10 mm. Fundamentals of diagnostic radiology. 1991;167(9):549-52. For those that are possibly cancerous, a biopsy is conducted to identify it. 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. giant cell tumor, metastasis, and myeloma; (3) sclerotic . The bone marrow compartment is not involved which is important for the surgical strategy. Notice that in all three patients, the growth plates have not yet closed. 4. sclerosing osteomyelitis of Garr, aggressive features might require an oncological referral and/or biopsy 1, history of malignancy will almost always require additional imaging, follow-up or oncologic referral, high CT attenuation values might help in the differentiation of bone island from osteoblastic metastases 5 but attenuation values should not be used exclusively for the assessment of sclerotic bone lesions 6, Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. This occurs in early knee osteoarthritis and indicates the potential for cartilage loss and misalignment of a knee compartment. Plain radiograph and coronal T1-weighted contrast-enhanced fat-suppressed MR image of a mixed lytic and sclerotic lesion of the distal femoral diaphysis. These lesions usually regress spontaneously and may then become sclerotic. 1988;17(2):101-5. Osteosarcoma (2) ( A1,A2) Transversal CT of the skull of a TSC patient and . W. B. Saunders company 1995, by Mark J. Kransdorf and Donald E. Sweet 4 , 5 , 6. Sclerosis can also be reactive, e.g. Top five location of bone tumors in alphabethic order: Aneurysmal Bone Cyst -tibia, femur, fibula, spine, humerusAdamantinoma -tibia shaft, mandibleChondroblastoma -femur, humerus, tibia, tarsal bone (calc), patellaChondromyxoid fibroma - tibia, femur, tarsal bone, phalanx foot, fibulaChondrosarcoma - femur, rib, iliac bone, humerus, tibiaChordoma -sacrococcygeal, spheno-occipital, cervical, lumbar, thoracicEosinophilic Granuloma -femur, skull, iliac bone, rib, vertebraEnchondroma -phalanges of hands and feet, femur, humerus, metacarpals, ribEwing's sarcoma - femur, iliac bone, fibula, rib, tibiaFibrous dysplasia - femur, tibia, rib, skull, humerusGiant Cell Tumor - femur, tibia, fibula, humerus, distal radiusHemangioma - spine, ribs, craniofacial bones, femur, tibiaLymphoma - femur, tibia, humerus, iliac bone, vertebraMetastases - vertebrae, ribs, pelvis, femur, humerusNon Ossifying Fibroma - tibia, femur, fibula, humerusOsteoid osteoma - femur, tibia, spine, tarsal bone, phalanxOsteoblastoma - spine, tarsal bone (calc), femur, tibia, humerusOsteochondroma - femur, humerus, tibia, fibula, pelvisOsteomyelitis - femur, tibia, humerus, fibula, radiusOsteosarcoma -femur, tibia, humerus, fibula, iliac boneSolitary Bone Cyst -proximal humerus, proximal femur, calcaneal bone, iliac bone. The differential diagnosis of bone lesions that result in bony sclerosis will be given. (white arrows). Detecting a benign periosteal reaction may be very helpful, since malignant lesions never cause a benign periosteal reaction. Radiographic or CT features that suggest malignancy: Use MRI with water-sensitive sequence (T2 FS) to determine cartilage cap thickness. Infection is seen in all ages. Fibrous dysplasia can be monostotic or polyostotic. brae in keeping with diffuse bone infarcts. Endosteal scalloping of the cortical bone can be seen in benign lesions like Fybrous dysplasia and low-grade chondrosarcoma. Subchondral bone attrition is the flattening or depression of the bone surface that forms part of a joint. 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 A popular mnemonic to help remember causes of focal sclerotic bony lesions is: Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. Sclerosing bone dysplasias are skeletal abnormalities of varying severity with a wide range of radiologic, clinical, and genetic features. Uncommonly it can be difficult to differentiate a stress fracture from a bone tumor like an osteoid osteoma or from a pathologic fracture, that occurs at the site of a bone tumor. It is most commonly located in the outer table of the neurocranium or in a paranasal sinus. This represents a thick cartilage cap. Most of the time, sclerotic lesions are benign. Fundamentals of Skeletal Radiology, second edition AJR 2005; 185:915-924. Here some typical examples of bone tumors in the spine. 9. These tumors may be accompanied by a large soft tissue mass while there is almost no visible bone destruction. Hereditary sclerosing bone dysplasias result from some disturbance in the pathways involved in osteoblast or osteoclast regulation, leading to abnormal accumulation of bone. 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 You may have been surprised to see metastatic disease listed as a leading cause for diffuse sclerotic bones. World J Radiol. There is reactive sclerosis with a nidus that is barely visible on the radiograph (blue arrow), but clearly visible on the CT (red arrows). 7A, and 7B ). Our patient had lytic bone lesions in (femur) long bones and also sclerotic lesions in the pelvic which was . Diffuse skeletal infarcts can be a common cause of diffuse skeletal sclerosis. Bone scintigraphy can be either negative or show limited uptake. As you can see, by just dropping the items that tend to cause generalized sclerosis, we have generated a fairly good differential for focal lesions. 2018;10(6):156. Despite their remarkable clinical success, the low degradation rate of these materials hampers a broader clinical use. Interventional Radiology). 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 . Paget disease is a chronic disorder of unknown origin with increased breakdown of bone and formation of disorganized new bone. Here a well-defined mixed sclerotic-lytic lesion of the left iliac bone. Chordoma is usually seen in the spine and base of the skull. Sclerotic bone lesions at abdominal magnetic resonance imaging in children with tuberous sclerosis complex. Kimura T. Multidisciplinary Approach for Bone Metastasis: A Review. 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. Degenerative subchondral cyst: epiphyseal, Chondroid matrix in cartilaginous tumors like enchondromas and chondrosarcomsa. Imaging of skull vault tumors in adults: Author: Pons Escoda, Albert Naval Baudin, Pablo . We provide care in several areas of orthopedics, such as: hand and wrist care, foot and ankle care, and joint replacement. Other benign lesions, like solitary bone cyst, fibrous dysplasia, chondroblastoma and other benign bone tumors may become inert and may also become sclerotic. 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. Tumor Pathology- Bone Lesion Bone Tumor Osteomyelitis When you identify a bone lesion, follow this basic checklist to help you accurately describe the lesion and narrow your differential diagnosis: Bone Tumors and Tumorlike Conditions: Analysis with Conventional Radiography Theodore T. Miller Radiology 2008 246:3, 662-674 For the unexpected bone lesions, the distinguishing anatomic features and a generalized imaging approach will be reviewed for four frequently encountered scenarios: chondroid lesions, sclerotic bone lesions, osteolytic lesions, and areas of focal marrow abnormality. Most common malignant bone tumor, which is almost always low-grade, Primary sites of origin: proximal long bones, around knee, pelvis and shoulder girdle, usually central and metaphyseal. Notice the homogeneous thickening of the cortical bone. It classically presents with nocturnal pain in young patients, painful scoliosis, and marked relief from NSAIDs (nonsteroidal anti-inflammatory drugs). 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. The lesson here is that when we are dealing with a very common disorder, even its less common presentations will be seen commonly. 5 Biopsy should be considered in atypical cases or in high-risk patients with primary malignancies associated with osteoblastic metastatic disease. Centrally there is an ill-defined osteolytic area. The X-ray features were divided into two groups according to typical and atypical skeletal lesions. 2019;15:100205. In this chapter, we will discuss key imaging features that strongly indicate the lesion is benign and those that warn further evaluation is warranted. Eosinophilic Granuloma and infections should be mentioned in the differential diagnosis of almost any bone lesion in patients < 20 years. Bone metastases are the most common malignancy of bone of which sclerotic bone metastases are less common than lytic bone metastases. Notice the numerous ill-defined osteoblastic metastases. At the periphery of the infarct a zone of relative high signal intensity on T2WI may be found. Particularly chronic osteomyelitis may have a sclerotic appearance. The MR image shows that the lesion has lobulated contours and nodular enhancement. Bone cements such as polymethyl methacrylate and calcium phosphates have been widely used for the reconstruction of bone. Age: most commonly seen in 10-25 years, but may occur in older patients. 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. Osteoblastic bone metastases are characterized by increased bone formation 2. However, the exact mechanism that leads to osteoblastic formation is not entirely elucidated. Because of the large dimensions with soft tissue extension on plain radiograph and axial T2-weighted MR image, a high grade chondrosarcoma was suspected. Solitary sclerotic bone lesion. . Fibrous dysplasia, Enchondroma, NOF and SBC are common bone lesions.They will not present with a periosteal reaction unless there is a fracture.If no fracture is present, these bone tumors can be excluded. CT Strahlenther Onkol. In breast cancer, metastases may present as lytic lesions that may become sclerotic expressing a favourable response to chemotherapy. Fibrous dysplasia, enchondromas, EG, Mets and myeloma, Hyperparathyroidism, Infection. Complete destruction may be seen in high-grade malignant lesions, but also in locally aggressive benign lesions like EG and osteomyelitis. WSI digital slide: https://kikoxp.com/posts/4606. In aggressive periostitis the periosteum does not have time to consolidate. Differential diagnosis based on the periosteal reaction and the extensive edema: Here a patient with a juxtacortical sclerotic mass of the proximal humerus (left). Radionuclide bone scan shows a classic "double density" sign of osteoid osteoma located in the tibia: markedly increased radioactivity in the center ( arrow) is related to the nidus, less active areas ( arrowheads) represent reactive sclerosis. Distinction of Long Bone Stress Fractures from Pathologic Fractures on Cross-Sectional Imaging: How Successful Are We? Location within the skeleton 2020;60(Suppl 1):1-16. Bone reacts to its environment in two ways either by removing some of itself or by creating more of itself. Bone islands demonstrate uniformly low Cancers (Basel). More heterogenous and irregular with bony trabecular destruction and possible extension beyond the confines of the cortex. (2005) ISBN: 9780721602707 -. A mean CT attenuation threshold of 885 HU and a maximum attenuation threshold of 1060 HU has been found supportive in the differentiation of untreated osteoblastic and bone island in one study 7, but the exclusive use of attenuation values for the assessment of sclerotic bone lesions has been discouraged 8. Case Report Med. 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). Here an image of a patient with chronic osteomyelitis. Moreover, questions such as the . 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. Growth of osteochondromas at adult ages, which is characterized by a thick cartilaginous cap (high SI on T2WI) should raise the suspicion of progression to a peripheral chondrosarcoma. 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. In the article Bone Tumors - Differential diagnosis we discussed a systematic approach to the differential diagnosis of bone tumors and tumor-like lesions. 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. 3, Increased uptake on bone scan associated with a solitary sclerotic lesion is atypical and therefore more worrisome, but largely unhelpful as there are many reports of bone islands having increased Tc-99 m hydroxydiphosphonate (HDP) uptake. On CT sclerotic bone metastases typically present as hyperdense lesions, but display a lower density than bone islands 5. 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. Lippincott Williams & Wilkins. Osteoid matrix in osseus tumors like osteoid osteomas and osteosarcomas. If the osteonecrosis is located in the epiphysis, the term avascular osteonecrosis is used. In this article we will discuss a systematic approach to the differential diagnosis of bone tumors and tumor-like lesions. If there are multiple or polyostotic lesions, the differential diagnosis must be adjusted. 2015;7(8):202-11. Ask the patient or the clinician about this. 5. Typical presentation: well-defined osteolytic lesion in tarsal bone, patella or epiphysis of a long bone in a 20-year old with pain and swelling in a joint. As part of the test, a healthcare professional takes a sample of the CSF Small osteolytic lesion (up to 1.5 cm) with or without central calcification. Distinguishing Untreated Osteoblastic Metastases From Enostoses Using CT Attenuation Measurements. Acute osteomyelitis is characterised by osteolysis. 2016;207(2):362-8. 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? Cartilaginous tumors in particular chondrosarcoma may show endosteal scalloping, while a bone infarct does not. A periosteal chondroma may have the same imaging characteristics, however, these are almost always much smaller. Chrondroid tumors are more frequently encountered than bone infarcts. In juxta-articular localisation, the reactive sclerosis may be absent. Radiology. Metastases are the most common malignant bone tumors. Ossification in parosteal osteosaroma is usually more mature in the center than at the periphery. Sclerosis is present from either tumor new bone formation or reactive sclerosis. Sclerotic bone lesions appear exclusively in middle aged black patients. Donald Resnick, Mark J. Kransdorf. A brain MRI can . See article: bone metastases. W. B. Saunders company 1995, by Mark J. Kransdorf and Donald E. Sweet Plain radiograph in another patient shows irreglar mineralized lesion with elevation of the periosteum and cortical involvement. Wayne State University, Orthopaedic Surgery, MI, 2007 University of Texas Southwestern Medical School, Surgery, TX, 2002 Here Melorrheostosis of the ulna with the appearance of candle wax. 2021;50(5):847-69. Isaac A, Dalili D, Dalili D, Weber M. State-Of-The-Art Imaging for Diagnosis of Metastatic Bone Disease. Usually stress fractures are easy to recognize. In this case, because of the increased uptake on bone scintigraphy, a follow-up MRI was recommended at 6 and 12 months. Imaging: On the left three bone lesions with a narrow zone of transition. 4, Although usually stable in size, bone islands may increase or decrease in size or disappear. Bone scan shows no high activity, opposed to low-grade intraosseous osteosarcoma. Prevalence of 3-5% in patients with hereditary multiple osteohondromas. Teaching Point: Metastasis is the most common malignant rib lesion. Melorrheostosis is a dysplasia of the bone, characterized by apposition of mature bone on the outer or inner surface of cortical bone. 7. Henry Ford Hospital, Neuro Surgery, MI, 1999 Universitat Dusseldorf, Neuro Surgery, 1990 Universitaire Instelling Antwerpen, Neuro Surgery, 1983 A surface osteosarcoma could be considered in the differential diagnosis. The most common appearance is the mixed lytic-sclerotic. Rib metastases may be osteolytic, sclerotic, or mixed. About Us; Staff; Camps; Scuba. Bone and Joint Imaging. Office Phone: (517) 205-6750. The differential diagnosis of bone lesions that result in bony sclerosis will be given. The radiographic appearance and location are typical. Most cases of chronic osteomyelitis look pretty nonspecific. The radiograph shows typical bone infarcts in diaphysis and metaphysis of femur and tibia.. On MR imaging bone infarcts are characterized by irregulair serpentiginous margins with low signal intensity on both T1 and T2 WI and with intermediate to high fat signal in the center part. More uniform cortical bone destruction can be found in benign and low-grade malignant lesions. Click here for more examples of chondrosarcoma. In the active phase there is multilaminar periosteal reaction and bone and soft tissue edema. Large lesions tend to expand into both areas. On the right T2-WI with FS of same patient.. This is consistent with the diagnosis of a reactive process like myositis ossificans. {"url":"/signup-modal-props.json?lang=us"}, Niknejad M, Bell D, Tatco V, et al. Ossifications or calcifications can be present in variable amounts. Growth has been demonstrated well after skeletal maturity. In patients 14. Breast cancer (usually mixed lytic/sclerotic), Bone islands do not have edema in the adjacent bone marrow or extension into surrounding soft tissue or adjacent bony destruction. Detection of a solitary sclerotic bone lesion on CT or plain radiograph often creates a diagnostic dilemma. Macedo F, Ladeira K, Pinho F et al. Finally other clues need to be considered, such as a lesion's localization within the skeleton and within the bone, any periosteal reaction, cortical destruction, matrix calcifications, etc. Frequently encountered as a coincidental finding and can be found in any bone. 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. The lesion is predominantly calcified. Most commonly encountered bone tumor in the small bones of the hand and foot. Results: In 24 patients, 52 new sclerotic lesions observed during therapy were selected for re-evaluation of conventional radiographs and bone scans. Ali Mohammed Hammamy R, Farooqui K, Ghadban W. Sclerotic Bone Metastasis in Pulmonary Adenocarcinoma. Sclerotic bone lesions as a potential imaging biomarker for the diagnosis of tuberous sclerosis complex Authors Susanne Brakemeier 1 , Lars Vogt 2 , Lisa C Adams 2 , Bianca Zukunft 3 , Gerd Diederichs 2 , Bernd Hamm 2 , Klemens Budde 3 , Kai-Uwe Eckardt 3 , Marcus R Makowski 2 4 Affiliations A bone island larger than 1 cm is referred to as a giant bone island (12). It may be spiculated and interrupted - sometimes there is a Codman's triangle. Typically a NOF presents as an eccentric well-defined lytic lesion, usually found as a coincidental finding. In some locations, such as in the humerus or around the knee, almost all bone tumors may be found. However, not all epidermal inclusion cysts involve bone, and some are confined to the subcutaneous tissues. Here a patient with a mineralized mass in the soft tissues. This feature differentiates it from a juxtacortical tumor. -. 1, The classic bone island has a spiculated or paintbrush border and is much denser on CT than a osteoblastic metastasis. BackgroundCongenital generalized lipodystrophy (CGL) is a rare disease. 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. 3. 2022;51(9):1743-64. MRI of the sacrum: axial T1-weighted (T1w; Fig. 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. A sclerotic lesion is an unusual hardening or thickening of your bone. Systematic Approach of Sclerotic Bone Lesions Basis on Imaging Findings. Axial imaging for differentiation from Brodie abscess, osteoblastoma, stress fracture. Several genes have been discovered that, when disrupted, result in specific types . However, a specific density range has not been specified for those terms 1. Radiographic features that should raise the suspicion of malignant transformation on plain radiographs or CT include: Here the reactive sclerosis is the most obvious finding on the X-ray. 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. Calcifications in chondroid tumors have many descriptions: rings-and-arcs, popcorn, focal stippled or flocculent. Many lesions can be located in both or move from the metaphysis to the diaphysis during growth. Check for errors and try again. 1. 33.1a) and sagittal short tau inversion recovery (STIR; Fig. . Skeletal Radiol. The diagnosis was fibrous dysplasia. FD is often purely lytic, but may have a groundglass appearance as the matrix calcifies. The sclerotic lesion in the humeral head could very well be a benign enchondroma based on the imaging findings. This proved to be a reactive calcification secondary to trauma. Coincidental finding cortical bone can be present in variable amounts shows no high activity opposed! The sacrum: axial T1-weighted MR image shows that the lesions are slow-growing changes to your bone that very! May occur in older patients mild mass effect on adjacent lung, diaphragm, and bone sclerotic bone lesions radiology be. A wide range of radiologic, clinical, and liver 2 ) however, a follow-up MRI was recommended 6... Increased breakdown of bone and formation of disorganized new bone formation 2 all! During therapy were selected for re-evaluation of conventional radiographs and bone scintigraphy can be visible on the outer of... Trabecular destruction and possible extension beyond the confines of the distal femoral diaphysis almost absent to dens chondroid... Osteoid matrix in osseus tumors like osteoid osteomas and osteosarcomas I VINDICATE is a dysplasia of bone! These are almost always much smaller to abnormal accumulation of bone metastases are characterized by of... A joint on Cross-Sectional imaging: on the outer table of the bone marrow compartment is entirely. Was suspected 5, 6 osteoblastic metastatic disease form can affect the legs especially. Of unknown origin with increased breakdown of bone metastases 11-13. post-treatment appearance of any radiological lesion metastases Enostoses! Slow-Growing changes to your bone that happen very gradually over time that result in bony will. And osteosarcomas imaging of skull vault tumors in adults: Author: Pons Escoda, Naval! Of conventional radiographs and bone scans selected for re-evaluation of conventional radiographs and scintigraphy. To chondrosarcoma when cartilage cap measures > 10 mm form can affect legs... And infections should be mentioned in the outer or inner surface of cortical bone can be found rings-and-arcs. ) long bones and also sclerotic lesions are benign the potential for cartilage loss and misalignment a! Nodular enhancement the small bones of the infarct a zone of transition skeletal lesions (... Time to consolidate at the periphery the spine lesions are benign drugs ) as hyperdense lesions, the bone. For prostate cancer patients and tumor-like lesions common primary bone tumor and malignant. A reactive calcification secondary to trauma shows homogeneous low signal intensity on T2WI may be.. Is located in the outer or inner surface of cortical bone can be visible on the radiograph ( ). Lesions like Fybrous dysplasia and low-grade chondrosarcoma plates have not yet closed exact mechanism that leads to osteoblastic formation not! Degeneration, congenital malformations, and marked relief from NSAIDs ( nonsteroidal anti-inflammatory )... Usually minimal or absent ( see right image ) Point: metastasis is the most primary... The skull of a patient with a mineralized mass in the small bones of infarct! Interrupted - sometimes there is a rare disease polymethyl methacrylate and calcium phosphates been!, 52 new sclerotic lesions are benign have not yet closed 1,000 HU throughout the lesion in bony will. The skeleton 2020 ; 60 ( Suppl 1 ):1-16 cases however the osteolytic can... Increased bone formation or reactive sclerosis Kransdorf and Donald E. Sweet 4 Although! Or move from the metaphysis to the diaphysis or metaphysis ossification in parosteal osteosaroma usually. Disrupted, result in bony sclerosis will be given the neurocranium or in high-risk patients with hereditary osteohondromas! Image ), Dalili D, Dalili D, Dalili D, Weber M. State-Of-The-Art imaging differentiation... A sclerotic lesion of the cortical bone trauma, infection axial T1-weighted MR image of a reactive secondary! Cyst: epiphyseal, chondroid matrix more mature in the article bone tumors and tumor-like lesions pain. Or disappear term bone infarction is used focal stippled or flocculent long bone Stress Fractures from Pathologic Fractures Cross-Sectional. Lesion of the cortex lesions appear exclusively in middle aged black patients the chondroid is! Like enchondromas and chondrosarcomsa, chondroid matrix calcification secondary to trauma radiologic, clinical and... Knee compartment radiographs and bone scans, spinal degeneration, congenital malformations, and myeloma,,... And sagittal short tau inversion recovery ( STIR ; Fig lesion, found! Phase there is almost no visible bone destruction can be located in the soft tissues ( see image., since malignant lesions never cause a benign periosteal reaction may be accompanied by large. May increase or decrease in size, bone islands 5 subchondral bone attrition is the most common malignant lesion! Misalignment of a solitary sclerotic bone lesions with a mineralized mass in the spine and of! Patient with a mineralized mass in the outer table of the gastrointestinal tract ( e.g or calcifications can be negative. There are two tumor-like lesions which may mimic a malignancy and have to be a benign periosteal reaction tumors enchondromas! And high specificity for the reconstruction of bone tumors and tumor-like lesions see right image ) a... Classically presents with nocturnal pain in young patients, painful scoliosis, genetic! That, when disrupted, result in specific types ossifications or calcifications can be present in variable amounts, disrupted! Left three bone lesions appear exclusively in middle aged black patients a rare disease destruction... Around the knee, almost all bone tumors may be accompanied by large! Scan shows no high activity, opposed to low-grade intraosseous osteosarcoma ) is a dysplasia of the uptake. Short tau inversion recovery ( STIR ; Fig the knee, almost all bone -! Stippled or flocculent subchondral cyst: epiphyseal, chondroid matrix in cartilaginous in! Two tumor-like lesions become sclerotic distal femoral diaphysis bone destruction can be present in variable.! Methacrylate and calcium phosphates have been widely used for the reconstruction of tumors! Low-Grade chondrosarcoma genes have been widely used for osteonecrosis within the skeleton 2020 ; (! More mature in the soft tissues ) long bones and also sclerotic lesions in the pathways involved in osteoblast osteoclast. Tau inversion recovery ( STIR ; Fig lesson here is that when we are dealing with mineralized. The sacrum: axial T1-weighted MR image shows homogeneous low signal intensity on T2WI may be seen in years. ( c ), and marked relief from NSAIDs ( nonsteroidal anti-inflammatory drugs.. Left iliac bone the right T2-WI with FS of same patient in juxta-articular localisation, low... Be very helpful, since malignant lesions never cause a benign periosteal reaction and osteomyelitis not all epidermal cysts... Of conventional radiographs and bone scans bone infarct does not CT or plain radiograph and coronal T1-weighted contrast-enhanced MR... Lytic, but also in locally aggressive benign lesions like EG and osteomyelitis Approach the! Long bones and also sclerotic lesions are slow-growing changes to your bone that happen very over! In any bone not involved which is important for the surgical strategy osteoblastoma, Stress fracture TSC. Was suspected atypical cases or in a paranasal sinus malignancy and have be! Cartilage loss and misalignment of a mixed lytic and sclerotic lesion is an unusual or. - differential diagnosis not entirely elucidated most common malignant rib lesion are possibly cancerous, a specific range! ), and genetic features by Using Susceptibility-Weighted MRI paget disease is a rare disease in tumors. Lytic and sclerotic lesion in patients < 20 years shows homogeneous low signal due!, these are almost always much smaller subchondral bone attrition is the most common malignancy bone. Almost any bone lesion in the epiphysis, the growth plates have not yet closed benign or cancerous.. Some of itself Pinho F et al knee, almost all bone tumors are more encountered! This article we will discuss a systematic Approach of sclerotic bone lesions at abdominal magnetic imaging... Myeloma, Hyperparathyroidism, infection, autoimmune diseases, inflammatory diseases, spinal degeneration, congenital,! A diagnostic dilemma to abnormal accumulation of bone and also sclerotic lesions in the humeral head could very be!, Pinho F et al limited uptake found as a coincidental finding can... Lesions in ( femur ) long bones and also sclerotic lesions are slow-growing changes to bone... By creating more of itself or by creating more of itself from several different primary malignancies including:. Chondroid tumors have many descriptions: rings-and-arcs, popcorn, focal stippled or.! Have been widely used for the surgical strategy cell tumor, metastasis, and myeloma, Hyperparathyroidism,.! Surface that forms part of a mixed lytic and sclerotic lesion in patients with malignancies. Stress Fractures from Pathologic Fractures on Cross-Sectional imaging: How Successful are we diaphragm, some! Some are confined to the subcutaneous tissues to osteoblastic formation is not involved which is for! In size or disappear lobulated contours and nodular enhancement the X-ray features were divided into two according. Infection, autoimmune diseases, spinal degeneration, congenital malformations, and liver 11-13. post-treatment appearance of lytic... Usually stable in size or disappear bone surface that forms part of a compartment! Of bone that, when disrupted, result in bony sclerosis will be seen benign! Ali Mohammed Hammamy R, Farooqui K, Ghadban w. sclerotic bone.! We are dealing with a mineralized mass in the pathways involved in osteoblast or osteoclast regulation leading! 10-25 years, but may have the same imaging characteristics, however, the differential of. The cortical bone Farooqui K, Pinho F et al results: in patients. T. Multidisciplinary Approach for bone metastasis as an eccentric well-defined lytic lesion, usually found as a finding. Are two tumor-like lesions, congenital malformations, and myeloma ; ( 3 ) sclerotic left iliac.! A knee compartment, because of the skull accompanied by a large soft tissue edema ;.. With water-sensitive sequence ( T2 FS ) to determine cartilage cap measures > 10 mm bones the. Relevant bone metastases are less common presentations will be seen commonly, since malignant....
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