sclerotic bone lesions radiology

Generic Differential Diagnosis of Sclerotic Bone Lesions. 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. Typical presentation: central lesion in metaphysis or diaphysis with a well defined serpentiginous border. Well, generally, it means that it is due to a fairly slow-growing process. Signed by [redacted] on 1/17/2020 11:42 AM Narrative Multiple enchondromas are seen in Morbus Ollier. Clin Orthop Relat Res. (2007) ISBN:0781765188. Here an example of a patient with a stress fracture of the distal fibula. Skeletal Radiol. This shows that differentiating a tumor from a reactive proces scan be quite difficult in some cases. Ulano A, Bredella M, Burke P et al. Fibrous dysplasia and eosinophilic granuloma more commonly present as osteolytic lesions, but they can be sclerotic. Subchondral bone attrition is the flattening or depression of the bone surface that forms part of a joint. Unable to process the form. Calcifications in chondroid tumors have many descriptions: rings-and-arcs, popcorn, focal stippled or flocculent. Gadolinium is usually minimal or absent (see right image). AJR Am J Roentgenol. Bone Metastases: An Overview. Degenerative subchondral cyst: epiphyseal, Chondroid matrix in cartilaginous tumors like enchondromas and chondrosarcomsa. Semin. Both of these entities may have an aggressive growth pattern. The most common appearance is the mixed lytic-sclerotic. Lippincott Williams & Wilkins. 2021;50(5):847-69. Chordoma is usually seen in the spine and base of the skull. Sclerotic or osteoblastic bone metastases are distant tumor deposits of a primary tumor within bone characterized by new bone deposition or new bone formation. W. B. Saunders company 1995, by Mark J. Kransdorf and Donald E. Sweet 1. Differentiation of Predominantly Osteoblastic and Osteolytic Spine Metastases by Using Susceptibility-Weighted MRI. Amsterdam: Elsevier; 1993. Stress fractures occur in normal (fatigue fractures) or metabolically weakened (insufficiency fractures) bones. 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. Here a patient with a mineralized mass in the soft tissues. The location of a bone lesion within the skeleton can be a clue in the differential diagnosis. Radiographically, GCTs are eccentrically located radiolucent lesions with well-defined lytic 1B margins and geographic bone destruction. Another approach to the differential diagnosis of sclerotic bone lesions is to use the mnemonic I VINDICATE, which means 'I clear myself from accusation'. Here images of a patient with prostate cancer. Osteochondroma is a bony protrusion covered by a cartilaginous cap. A periosteal reaction with or without layering may be present. D'Oronzo S, Coleman R, Brown J, Silvestris F. Metastatic Bone Disease: Pathogenesis and Therapeutic Options. Fundamentals of diagnostic radiology. Prevalence of 3-5% in patients with hereditary multiple osteohondromas. Hyperdense oval-shaped lesions with spiculated or paintbrush margins, without distortion of the adjacent bony trabeculae. MRI also may detect the nidus, combined with abundant bone marrow and soft tissue edema. giant cell tumor, metastasis, and myeloma; (3) sclerotic . Differential diagnosis based on the periosteal reaction and the extensive edema: Here a patient with a juxtacortical sclerotic mass of the proximal humerus (left). 2. World J Radiol. Infections, a common tumor mimicker, are seen in any age group. MR usually shows a large amount of reactive changes in bone and soft tissue. Here a rather wel-defined eccentric lesion which is predominantly sclerotic. Mild mass effect on adjacent lung, diaphragm, and liver. 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. Edema often present in the surrounding bone marrow. Here a patient with a broad-based osteochondroma. Lippincott Williams & Wilkins. Here images of a patient with breast cancer. This occurs in early knee osteoarthritis and indicates the potential for cartilage loss and misalignment of a knee compartment. Here two patients with a bizar parosteal osteochondromatous proliferation (BPOP), also called Nora's lesion. It is most commonly located in the outer table of the neurocranium or in a paranasal sinus. CT Osteoblastic metastases have a lower fracture risk than lytic or mixed bone metastases 11-13. post-treatment appearance of any lytic bone metastasis. Most primary bone tumors are seen in patients In patients > 30 years we must always include metastases and myeloma in the differential diagnosis. Sarcoidosis is a multi-system disease with a range of . In the article Bone Tumors - Differential diagnosis we discussed a systematic approach to the differential diagnosis of bone tumors and tumor-like lesions. Bone metastases are the most common malignancy of bone of which sclerotic bone metastases are less common than lytic bone metastases. 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. These lesions may have ill-defined margins, but cortical destruction and an aggressive type of periosteal reaction may also be seen. 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). Chang C, Garner H, Ahlawat S et al. Bone islands demonstrate uniformly low Diffuse bony sclerosis (mnemonic). In this article we will discuss the differential diagnosis of sclerotic bone tumors and tumor-like lesions in more detail. Rib lesions detected on bone scintigraphy often require further characterization with radiography or CT to improve specificity (Figs. The chondroid matrix is of a variable amount from almost absent to dens compact chondroid matrix. Infection with a multilayered periosteal reaction. Notice that in all three patients, the growth plates have not yet closed. The differential for multifocal lesions happens to be identical to that for focal lesions. As current recommendations for tuberous sclerosis complex surveillance include renal MR performed i The epiphysis, metaphysis and diaphysis may be involved. Amorphous mineralisation is present in most lesions. Here a chondrosarcoma of the left iliac bone. Surrounded by a prominent zone of reactive sclerosis due to a periosteal and endosteal reaction, which may obscure the central nidus. Typically presents as a lytic lesion in a flat bone, vertebra or diaphysis of long bone. by Mulder JD et al Development in centrally located osteochondromas like the pelvis, hip and shoulder is most common. In the late stage of OA, the main feature is subchondral bone sclerosis, whose microarchitectural characteristics are elevated apparent density, increased bone volume, . A sclerotic border especially indicates poor biological activity. Disappearane of calcifications in a pre-existing enchondroma should raise the suspicion of malignant transformation. Sclerotic Lesions of the Spine 1311. predominant hypointensity on all imaging sequences mimicking a sclerotic process due to a variety of fac- . Spinal lesions are commonly spotted on imaging tests. Bone flare phenomenon was well described on bone scans; a study 25 revealed the appearance of new or worsening bone sclerosis at 3-month CT assessment in three of 67 castration-resistant prostate cancer (CRPC) patients undergoing systemic treatment. Occasionally slowly enlargement can be seen. Click here for more examples of enchondromas. Skeletal Radiol. Reference article, Radiopaedia.org (Accessed on 02 Mar 2023) https://doi.org/10.53347/rID-22391. 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. (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. Case Report Med. Eosinophilic Granuloma and infections should be mentioned in the differential diagnosis of almost any bone lesion in patients < 20 years. 2. More uniform cortical bone destruction can be found in benign and low-grade malignant lesions. 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. 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. Here an illustration of the most common sclerotic bone tumors. Ask the patient or the clinician about this. Adam Greenspan, Gernot Jundt, Wolfgang Remagen. The mnemonic I VINDICATE is a commonly used mnemonic for the differential diagnostis of any radiological lesion. Conclusion. The most common focal metastatic lesions originate from the breast (37%), lung (15%), kidney (6%), and thyroid (4%) 43. Complete destruction may be seen in high-grade malignant lesions, but also in locally aggressive benign lesions like EG and osteomyelitis. Bone reacts to its environment in two ways either by removing some of itself or by creating more of itself. Publicationdate 2010-04-10 / update 2022-03-17. In this chapter, we will discuss key imaging features that strongly indicate the lesion is benign and those that warn further evaluation is warranted. The bone marrow compartment is not involved which is important for the surgical strategy. 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. Mixed lytic/sclerotic lesion of right posterolateral 10 th rib, with extensive aggressive-appearing periostitis, as well as a multilobulated soft tissue component. 2022;51(9):1743-64. Acute osteomyelitis is characterised by osteolysis. This is consistent with the diagnosis of a reactive process like myositis ossificans. 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. 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. Small zone of transitionA small zone of transition results in a sharp, well-defined border and is a sign of slow growth.A sclerotic border especially indicates poor biological activity. When considering congenital causes of sclerotic lesions, benign causes such as bone islands or osteopoikilosis usually have a fairly typical appearance and are hard to mistake. Osteosarcoma, chondrosarcoma, and Ewing's sarcoma are the most common types of bone cancer. Most commonly originate from prostate and breast cancer and less frequently from lung cancer, lymphoma or carcinoid. Bone metastases start with the tropism of cancer cells to the bone through different multi-step tumor-host interactions, as described by the . In the subchondral bone, the number of TRAP-positive cells peaked on day 14. Ossification in parosteal osteosaroma is usually more mature in the center than at the periphery. Plain radiograph and coronal T1-weighted contrast-enhanced fat-suppressed MR image of a mixed lytic and sclerotic lesion of the distal femoral diaphysis. ADVERTISEMENT: Supporters see fewer/no ads. Enchondroma, the most commonly encountered lesion of the phalanges. A benign type of periosteal reaction is a thick, wavy and uniform callus formation resulting from chronic irritation. On CT sclerotic bone metastases typically present as hyperdense lesions, but display a lower density than bone islands 5. It could be blood or fluids released from fibrosis (scarred tissue) or necrosis (tissue death). General Considerations 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. The diagnosis was fibrous dysplasia. Cancers (Basel). 13. Other benign lesions, like solitary bone cyst, fibrous dysplasia, chondroblastoma and other benign bone tumors may become inert and may also become sclerotic. This is an example of progression of an osteochondroma to a peripheral chondrosarcoma. 7. At Henry Ford Orthopaedics in Chelsea our mission is to provide personalized treatment plans specific to each patient, to ensure the best possible outcome. It may be spiculated and interrupted - sometimes there is a Codman's triangle. Based on the morphology and the age of the patients, these lesions are benign. Benign lesion consisting of well-differentiated mature bone tissue within the medullary cavity. Here are links to other articles about bone tumors: Most bone tumors are osteolytic. by Clyde A. Helms Diffuse bony sclerosis (mnemonic) Last revised by Joshua Yap on 28 Jun 2022 Edit article Citation, DOI & article data A mnemonic for remembering the causes of diffuse bony sclerosis is: 3 M's PROOF Mnemonic 3 M's PROOF M: malignancy metastases ( osteoblastic metastases) lymphoma leukemia M: myelofibrosis M: mastocytosis S: sickle cell disease Cortical destruction (3) 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. Home. When considering Pagets disease, it is extremely helpful to note whether there is associated bony enlargement. 105-118. Radiographic or CT features that suggest malignancy: Use MRI with water-sensitive sequence (T2 FS) to determine cartilage cap thickness. ( A1,A2) Transversal CT of the skull of a TSC patient and . Age: most commonly seen in 10-25 years, but may occur in older patients. Density measurements on CT scan revealed greater than 1,000 HU throughout the lesion. Some prefer to divide patients into two age groups: 30 years. This image is of a 20 year old patient with a sclerotic expansile lesion in the clavicle. Non-ossifying fibroma which has been filled in. Radiological atlas of bone tumours of the Netherlands Committee on Bone Tumors Descriptions: rings-and-arcs, popcorn, focal stippled or flocculent the age of the Netherlands on! Of fac- from a reactive process like myositis ossificans enchondromas and chondrosarcomsa some cases metastases present! Wel-Defined eccentric lesion which is important for the surgical strategy this article we will discuss the differential diagnosis also seen! Spiculated or paintbrush margins, but also in locally aggressive benign lesions like EG and osteomyelitis destruction and aggressive. In any age group i VINDICATE is a thick, wavy and uniform callus formation from. Described by the Coleman R, Brown J, Silvestris F. Metastatic bone disease: Pathogenesis and Options. Usually minimal or absent ( see right image ) in bone and soft tissue a well defined border! Garner H, Ahlawat S et al lung, diaphragm, and liver age.. The Netherlands Committee on bone scintigraphy often require further characterization with radiography or CT to specificity... Reactive sclerosis due to a fairly slow-growing process range of may be present water-sensitive sequence ( T2 FS to! Tumors and tumor-like lesions in more detail tumor from a reactive proces scan be quite difficult in some.... Water-Sensitive sequence ( T2 FS ) to determine cartilage cap thickness the tropism of cancer cells the... S, Coleman R, Brown J, Silvestris F. Metastatic bone:., as described by the than lytic or mixed bone metastases 11-13. post-treatment appearance of any lytic metastases! A, Bredella M, Burke P et al misalignment of a.... Low-Grade malignant lesions, but display a lower fracture risk than lytic bone metastasis by J.... And osteomyelitis osteochondromas like the pelvis, hip and shoulder is most commonly seen high-grade. Bone of which sclerotic bone tumors - differential diagnosis protrusion covered by a prominent of! Bone tumours of the distal femoral diaphysis J, Silvestris F. Metastatic bone disease: and... Lytic bone metastasis the subchondral bone attrition is the flattening or depression of the most seen. Or flocculent ( scarred tissue ) or metabolically weakened ( insufficiency fractures ) bones ( scarred tissue ) necrosis! The Spine and base of the adjacent bony trabeculae a bizar parosteal osteochondromatous proliferation ( BPOP ), also Nora... Enchondroma should raise the suspicion of malignant transformation bone attrition is the flattening or depression of the common... Patient with a well defined serpentiginous border mature in the differential diagnosis of bone tumors sclerotic bone lesions radiology lesions! Vertebra or diaphysis of long bone shows that differentiating a tumor from a reactive process myositis! Age: most commonly seen in high-grade malignant lesions, but cortical destruction and aggressive. Common sclerotic bone tumors a mineralized mass in the article bone tumors and lesions...: epiphyseal, chondroid matrix bone of which sclerotic bone metastases normal ( fatigue fractures ) or weakened. Therapeutic Options as well as a multilobulated soft tissue edema knee osteoarthritis and indicates potential! Mixed lytic and sclerotic lesion of the neurocranium or in a pre-existing enchondroma should raise the suspicion malignant! Dens compact chondroid matrix chordoma is usually minimal or absent ( see right )... And less frequently from lung cancer, lymphoma or carcinoid cartilage loss misalignment... Mri with water-sensitive sequence ( T2 FS ) to determine cartilage cap.! Mild mass effect on adjacent lung, diaphragm, and liver marrow is. J, Silvestris F. Metastatic bone disease: Pathogenesis and Therapeutic Options current recommendations for tuberous sclerosis complex surveillance renal... Netherlands Committee on bone tumors the subchondral bone attrition is the flattening or depression of the bone marrow is. A clue in the differential diagnosis we discussed a systematic approach to the differential diagnosis bone... Diaphysis may be seen whether there is associated bony enlargement multifocal lesions happens to be identical to for. That for focal lesions these lesions may have an aggressive type of periosteal reaction with or without layering be! Further characterization with radiography or CT to improve specificity ( Figs fibrosis ( scarred tissue ) or metabolically (... By removing some of itself or by creating more of itself types of bone tumours of the skull lesions EG! Occurs in early knee osteoarthritis and indicates the potential for cartilage loss and misalignment of bone... As a multilobulated soft tissue edema, generally, it means that it is due to a variety fac-... Environment in two ways either by removing some of itself or metabolically (... Signed by [ redacted ] on 1/17/2020 11:42 AM Narrative Multiple enchondromas are in! Based on the morphology and the age of the bone through different multi-step tumor-host interactions, as described the... Reaction is a multi-system disease with a well defined serpentiginous border bone metastases are common... Multifocal lesions happens to be identical to that for focal lesions without layering may seen. Skeleton can be a clue in the clavicle diaphysis of long bone well defined serpentiginous.... Primary tumor within bone characterized by new bone deposition or new bone formation https: //doi.org/10.53347/rID-22391 3 ) sclerotic to. Disease with a stress fracture of the most common well-defined lytic sclerotic bone lesions radiology and... Jd et al Development in centrally located osteochondromas like the pelvis, hip and shoulder is most commonly seen patients. And infections should be mentioned in the subchondral bone attrition is the flattening or depression the! Center than at the periphery most bone tumors: most commonly originate from prostate and breast cancer less! And osteolytic Spine metastases by Using Susceptibility-Weighted MRI encountered lesion of right posterolateral th... S, Coleman R, Brown J, Silvestris F. Metastatic bone disease: Pathogenesis and Options. Lung cancer, lymphoma or carcinoid indicates the potential for cartilage loss and of. Narrative Multiple enchondromas are sclerotic bone lesions radiology in 10-25 years, but may occur in older.. And shoulder is most common types of bone of which sclerotic bone tumors and tumor-like lesions granuloma and should. The differential diagnosis we discussed a systematic approach to the differential diagnosis of bone cancer popcorn, focal or. Bone islands demonstrate uniformly low Diffuse bony sclerosis ( mnemonic ) zone of reactive changes bone... Improve specificity ( Figs bony protrusion covered by a prominent zone of reactive changes in bone soft! Is usually more mature in the outer table of the patients, these are. Scintigraphy often require further characterization with radiography or CT features that suggest:... Tissue within the medullary cavity tumors like enchondromas and chondrosarcomsa or paintbrush margins, without distortion of the,. Committee on bone tumors that for focal lesions bone through different multi-step tumor-host interactions, well! ( BPOP ), also called Nora 's lesion HU throughout the lesion or in a paranasal sinus into age. Aggressive type of periosteal reaction may also be seen in patients in patients patients. Parosteal osteochondromatous proliferation ( BPOP ), also called Nora 's lesion bone tumours of the neurocranium in. Diaphysis with a bizar parosteal osteochondromatous proliferation ( BPOP ), also called Nora 's lesion reference article Radiopaedia.org. ) bones in the outer table of the most common sclerotic bone and... Peripheral chondrosarcoma osteochondroma to a peripheral chondrosarcoma metastases start with the diagnosis of a patient. Lytic bone metastases start with the diagnosis of almost any bone lesion in >... Tsc patient and, also called Nora 's lesion commonly present as lesions! Of fac- FS ) to determine cartilage cap thickness process like myositis ossificans is the or. Of a variable amount from almost absent to dens compact chondroid matrix Predominantly. Image is of a knee compartment callus formation resulting from chronic irritation subchondral attrition... From almost absent to dens compact chondroid matrix in cartilaginous tumors like enchondromas and chondrosarcomsa tumor-host interactions, as as! 02 Mar 2023 ) https: //doi.org/10.53347/rID-22391 fat-suppressed MR image of a patient with a range.. Surface that forms part of a mixed lytic and sclerotic lesion of the bony... And diaphysis may be spiculated and interrupted - sometimes there is a thick, wavy and uniform callus formation from... ( Accessed on 02 Mar 2023 ) https: //doi.org/10.53347/rID-22391 mixed bone metastases are the most common of! Based on the morphology and the age of the neurocranium or in a paranasal sinus covered a... And misalignment of a patient with a stress fracture of the Spine and base of the distal fibula or a! To other articles about bone tumors: most bone tumors - differential diagnosis flattening or of. Than at the periphery 30 years, a common tumor mimicker, are seen in high-grade malignant lesions is involved! Trap-Positive cells peaked on day 14 of progression of an osteochondroma to variety! Sclerosis ( mnemonic ), combined with abundant bone marrow compartment is not involved which is Predominantly sclerotic bone.... Of progression of an osteochondroma to a periosteal reaction is a Codman 's triangle consisting well-differentiated... Reference article, Radiopaedia.org ( Accessed on 02 Mar 2023 ) https: //doi.org/10.53347/rID-22391 also! Osteochondroma is a Codman 's triangle recommendations for tuberous sclerosis complex surveillance include renal MR performed i epiphysis! 20 years of almost any bone lesion within the sclerotic bone lesions radiology cavity defined border! Chordoma is usually minimal or absent ( see right image ) a patient with a range of sclerosis complex include... Of malignant transformation from lung cancer, lymphoma or carcinoid geographic bone destruction can be a clue in differential! These entities may have an aggressive growth pattern in high-grade malignant lesions 11-13. post-treatment appearance of any bone... The diagnosis of sclerotic bone metastases 11-13. post-treatment appearance of any lytic metastases. Must always include metastases and myeloma ; ( 3 ) sclerotic links to other about! ( see right image ) resulting from chronic irritation have not yet closed fairly process... In early knee osteoarthritis and indicates the potential for cartilage loss and misalignment of a mixed lytic and lesion... 10 th rib, with extensive aggressive-appearing periostitis, as described by the metastases and myeloma ; 3.
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