Amsterdam: Elsevier; 1993. {"url":"/signup-modal-props.json?lang=us"}, Knipe H, Yap J, Masters M, et al. There are no calcifications. by Clyde A. Helms (see diagnostic imaging pearls). Enchondromas aswell as low-grade chondrosarcomas are frequently encountered as coincidental findings in patients who have a MRI or bone scan for other reasons. Axial T1-weighted MR image shows homogeneous low signal intensity due to the compact bone apposition. Urgency: Routine. A T1w/T2-weighted (T2w) hypointense nonexpansile lesion is seen involving the sacrum (asterisk). Parkinson's disease, multiple sclerosis, brain tumors and brain trauma [2]. Imaging: 7. Both imaging modalities achieved only a moderate correlation with DEXA. Bone Metastases: An Overview. Finally, we conclude with a case of an incidentally presenting sclerotic vertebral body lesion. Reference article, Radiopaedia.org (Accessed on 02 Mar 2023) https://doi.org/10.53347/rID-22391. On the left three bone lesions with a narrow zone of transition. Strahlenther Onkol. by Mulder JD, et al. Development in centrally located osteochondromas like the pelvis, hip and shoulder is most common. Paget disease is a chronic disorder of unknown origin with increased breakdown of bone and formation of disorganized new bone. (2007) ISBN:0781765188. Biopsy revealed dedifferentiated chondrosarcoma. CT imaging example of the location pattern of sclerotic bone lesions in the skull, spine, and pelvis of TSC patients and control subjects. 5 Biopsy should be considered in atypical cases or in high-risk patients with primary malignancies associated with osteoblastic metastatic disease. It can also be proven histologically. Sclerotic or osteoblastic bone metastases are distant tumor deposits of a primary tumor within bone characterized by new bone deposition or new bone formation. Rib lesions detected on bone scintigraphy often require further characterization with radiography or CT to improve specificity (Figs. A high grade chondrosarcoma must be considered in the differential diagnosis. Ulano A, Bredella M, Burke P et al. 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. Bone islands demonstrate uniformly low Spine (Phila Pa 1976). An ill-defined border with a broad zone of transition is a sign of aggressive growth (1). Here images of a patient with breast cancer. Osteoblastic metastatic disease (see Table 33.1): More often multiple with increased uptake on bone scan. The images show on the left a typical osteolytic NOF with a sharp sclerotic border. If the osteonecrosis is located in the epiphysis, the term avascular osteonecrosis is used. These are inert filled-in non-ossifying fibromas. The epiphysis, metaphysis and diaphysis may be involved. 2021;216(4):1022-30. Osteoblastic Metastatic Lesions. Here a well-defined mixed sclerotic-lytic lesion of the left iliac bone. 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. Radiological hallmark: formation of a chondroid (cartilagenous) matrix, which presents as punctuated, stippled or popcorn-like calcifications. A mnemonicfor remembering the causes of diffuse bony sclerosis is: ADVERTISEMENT: Supporters see fewer/no ads, Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. In patients > 30 years, and particularly > 40 years, despite benign radiographic features, a metastasis or plasmacytoma also have to be considered 1989. DD: juxtacortical chondrosarcoma, parosteal osteosarcoma. The mean and maximum attenuation were measured in Hounsfield units. 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. 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. Check for errors and try again. Here an image of a patient with chronic osteomyelitis. Large lesions tend to expand into both areas. Lets apply the good old universal differential diagnosis to sclerotic bone lesions. Osteopetrosis and pyknodysostosis are likewise hard to mistake for other entities since the bones are denser than in any other disorder, and the long bones tend to have very tiny medullary canals. Benign lesion consisting of well-differentiated mature bone tissue within the medullary cavity. Studies suggest that beyond joint wear and tear . Kimura T. Multidisciplinary Approach for Bone Metastasis: A Review. Chang C, Garner H, Ahlawat S et al. This shows that differentiating a tumor from a reactive proces scan be quite difficult in some cases. 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. 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. The differential diagnosis mostly depends on the age of the patient and the findings on the conventional radiographs. A periosteal reaction with or without layering may be present. Here images of an osteosarcoma in the right femur. In the active phase there is multilaminar periosteal reaction and bone and soft tissue edema. Other benign lesions, like solitary bone cyst, fibrous dysplasia, chondroblastoma and other benign bone tumors may become inert and may also become sclerotic. 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. Notice that CT depicts these lesions far better (red arrows). 2014;71(1):39. Edema often present in the surrounding bone marrow. Increased uptake on bone scan has been reported in bone islands, especially giant ones, but warrants imaging follow-up. Multiple enchondromas and hemangiomas are seen in Maffucci's syndrome. T2-weighted axial MR image demonstrates high signal intensity of the tumor in the metacarpal bone with extension of a lobulated soft tissue mass. Osteoid osteoma (2) Sclerotic bone metastases. Here a patient with a broad-based osteochondroma. Several genes have been discovered that, when disrupted, result in specific types . In the epiphysis we use the term avascular necrosis and not bone infarction. Enchondroma, the most commonly encountered lesion of the phalanges. 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. 5. When a reactive process is more likely based on history and imaging features, follow-up is sometimes still needed. 2015;7(8):202-11. Sclerotic bone lesions at abdominal magnetic resonance imaging in children with tuberous sclerosis complex. Plain radiograph and coronal T1-weighted contrast-enhanced fat-suppressed MR image of a mixed lytic and sclerotic lesion of the distal femoral diaphysis. 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. (2007) ISBN: 9780781779302 -. Central location most common with some expansion and cortical thinning. CT of Sclerotic Bone Lesions: Imaging Features Differentiating Tuberous Sclerosis Complex with Lymphangioleiomyomatosis from Sporadic Lymphangioleiomymatosis1. In 8 of the 24 patients, 17 of 52 new sclerotic lesions (33%) had showed positive uptake on previous bone scans. mutation, and both sclerotic and lytic bone lesions together for the first time. 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. Sclerotic or blastic bone metastases can arise from a number of different primary malignancies including prostate carcinoma (most common), breast carcinoma (may be mixed), transitional cell carcinoma (TCC), carcinoid, medulloblastoma, neuroblastoma, mucinous adenocarcinoma of the gastrointestinal tract (e.g., colon carcinoma, gastric carcinoma), In some locations, such as in the humerus or around the knee, almost all bone tumors may be found. Bone marrow edema can happen with fractures and other serious bone or joint injuries. 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. Non-ossifying fibroma which has been filled in. Here an incidental finding of several eccentric sclerotic lesions of the distal femur. Accordingly, growth of osteochondromas is allowed until a patient reaches adulthood and the physeal plates are closed. 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 . After an injury, different types of fluid can build up in a bone. When you are considering osteonecrosis in your differential diagnosis, look at the joints carefully. I think that the best way is to start with a good differential diagnosis for sclerotic bones. Lumbar CT-HU has the highest pooled correlation (r 2 =0.6) with both spine DEXA and lowest skeletal t-score followed by lumbar CT-HU with hip DEXA (r 2 =0.5) and lumbar MRI with hip (r 2 =0.44) and spine (r 2 =0.41) DEXA. Confavreux C, Follet H, Mitton D, Pialat J, Clzardin P. Fracture Risk Evaluation of Bone Metastases: A Burning Issue. As part of the test, a healthcare professional takes a sample of the CSF 4. They can affect any bone and be either benign (harmless) or malignant (cancerous). 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. DD: Ganglion cyst, osteomyelitis, GCT, ABC, enchondroma. Ewing sarcoma with lamellated and focally interrupted periosteal reaction. What does it mean that a lesion is sclerotic? Complete destruction may be seen in high-grade malignant lesions, but also in locally aggressive benign lesions like EG and osteomyelitis. 9. Typical presentation: central lesion in metaphysis or diaphysis with a well defined serpentiginous border. Lippincott Williams & Wilkins. Clin Orthop Relat Res. It may be spiculated and interrupted - sometimes there is a Codman's triangle. PET features high sensitivity in the detection of bone metastases especially 18 NaF-PET is suitable for the detection of sclerotic metastases since it shows tracer uptake in locations with osteoblastic activity and is more accurate than FDG-PET 3. Likewise patients with sclerotic lesions due to various drugs or minerals will tell you what they are taking if you ask them. Our patient had lytic bone lesions in (femur) long bones and also sclerotic lesions in the pelvic which was . 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. Lesions in the bone are usually identified on radiographic images - chiefly X-rays - but also on CT and MRI scans. Diffuse bony sclerosis (mnemonic). Most of the time, sclerotic lesions are benign. Spinal lesions are commonly spotted on imaging tests. In this case, because of the increased uptake on bone scintigraphy, a follow-up MRI was recommended at 6 and 12 months. 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. Patients with sclerotic lesions due to metastasis often have a history of prior malignant disease. Fundamentals of Skeletal Radiology, second edition Unable to process the form. AJR 2005; 185:915-924. 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 Infections, a common tumor mimicker, are seen in any age group. MRI of the sacrum: axial T1-weighted (T1w; Fig. Infection is seen in all ages. If the disorder it is reacting to is rapidly progressive, there may only be time for retreat (defense). 5. Skeletal Radiol. Bone cyst is one of the manifestations of CGL with AGPAT2 mutation. Notice how easily MRI depicts these lesions. Some prefer to divide patients into two age groups: 30 years. Bone metastases are the most common malignancy of bone of which sclerotic bone metastases are less common than lytic bone metastases. The mnemonic I VINDICATE is a commonly used mnemonic for the differential diagnostis of any radiological lesion. The use of radiological imaging in medical care dates back to 1895 when 10. Sclerotic bone metastases typically present as radiodense bone lesions that are round/nodular with relatively well-defined margins 3 . Fundamentals of diagnostic radiology. Here a rather wel-defined eccentric lesion which is predominantly sclerotic. More uniform cortical bone destruction can be found in benign and low-grade malignant lesions. There were other features that favored the diagnosis of a low-grade chondrosarcoma like a positive bone scan and endosteal scalloping of the cortical bone on an MRI (not shown). Sclerotic means that the lesions are slow-growing changes to your bone that happen very gradually over time. (2007) ISBN:0781765188. Giant cell bone tumors are usually benign (not cancerous) but the malignant form can affect the legs, especially near the knees. This benign reactive process is most commonly found adjacent to the cortex of phalanges of hands or feet (75%). The chondroid matrix is of a variable amount from almost absent to dens compact chondroid matrix. 2021;216(4):1022-30. More heterogenous and irregular with bony trabecular destruction and possible extension beyond the confines of the cortex. Cancers (Basel). -. The image on the right is of a different patient who has an old NOF that shows complete fill in. 2021;50(5):847-69. Adamantinoma in case of a sclerotic lesion with several lucencies of the tibia in a young patient. Common: Metastases, multiple myeloma, multiple enchondromas. Aggressive periosteal reaction There are calcified strands within the soft tissues. Check for errors and try again. In patients In patients > 30 years, and particularly > 40 years, despite benign radiographic features, a metastasis or plasmacytoma also have to be considered On the left three bone lesions with a narrow zone of transition. 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