A molecular classification has been also proposed. The most reliable indicator in determining whether these lesions are benign or malignant is the zone of transition between the lesion and the adjacent normal bone (1). Enchondromas aswell as low-grade chondrosarcomas are frequently encountered as coincidental findings in patients who have a MRI or bone scan for other reasons. {"url":"/signup-modal-props.json?lang=us"}, Knipe H, Yap J, Masters M, et al. 2 ed. 5. Here a patient with a broad-based osteochondroma with extension of the cortical bone into the stalk of the lesion. Distinction of Long Bone Stress Fractures from Pathologic Fractures on Cross-Sectional Imaging: How Successful Are We? On CT sclerotic bone metastases typically present as hyperdense lesions, but display a lower density than bone islands 5. Urgency: Routine. Sclerotic bone metastases typically present as radiodense bone lesions that are round/nodular with relatively well-defined margins 3. These are infections and eosinophilic granuloma. One of the first things you should notice about sclerotic bone lesions is whether they are single and focal, multifocal, or diffuse. DD: Ganglion cyst, osteomyelitis, GCT, ABC, enchondroma. Sometimes a more solid periosteal reaction is present combined with cortical thickening and broadening of the bone. More uniform cortical bone destruction can be found in benign and low-grade malignant lesions. In this chapter, we will discuss key imaging features that strongly indicate the lesion is benign and those that warn further evaluation is warranted. Generally, this just follows common sense some lesions should logically be expected to be focal, others multifocal, and yet others diffuse or systemic. In this article we will discuss the differential diagnosis of sclerotic bone tumors and tumor-like lesions in more detail. Most bone tumors are solitary lesions. General Considerations ImageBenign periosteal reaction in an osteoid osteoma.Large arrow indicates solid periosteal reaction.Small arrow indicates nidus. Most cases of chronic osteomyelitis look pretty nonspecific. 1988;17(2):101-5. 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. The diagnosis is usually established by a combination of imaging and the known presence of a primary tumor that is associated with sclerotic bone metastases. Likewise patients with sclerotic lesions due to various drugs or minerals will tell you what they are taking if you ask them. 13. Sclerotic bone metastases can arise from several different primary malignancies including 1-3: mucinous adenocarcinoma of the gastrointestinal tract (e.g. Reference article, Radiopaedia.org (Accessed on 02 Mar 2023) https://doi.org/10.53347/rID-22391. Differential Diagnosis in Orthopaedic Oncology. 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. Usually stress fractures are easy to recognize. Infection may be well-defined or ill-defined osteolytic, and even sclerotic. Non-ossifying fibroma which has been filled in. 5. Strahlenther Onkol. 4, Although usually stable in size, bone islands may increase or decrease in size or disappear. For example: Differential Diagnosis of Focal or Multifocal Sclerotic Bone Lesions. Polyostotic lesions > 30 years Patients usually have sclerotic bone lesions before and lytic bone lesions after puberty. The cortical bone and bone marrow compartment are not involved. A lumbar puncture (LP) is a diagnostic procedure used to obtain a sample of cerebrospinal fluid (CSF) to look for signs of infection or inflammation. A T1w/T2-weighted (T2w) hypointense nonexpansile lesion is seen involving the sacrum (asterisk). FD is often purely lytic, but may have a groundglass appearance as the matrix calcifies. Diagnostic brain imaging tests can assess bone fractures, structural problems, blood vessel abnormalities, and changes in brain metabolism. Other benign lesions, like solitary bone cyst, fibrous dysplasia, chondroblastoma and other benign bone tumors may become inert and may also become sclerotic. 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). Less dense on CT and more heterogeneous than bone islands. Office Phone: (517) 205-6750. Coronal MR image demonstrates subtle low intensity line representing the fracture. Bone cyst is one of the manifestations of CGL with AGPAT2 mutation. Bker S, Adams L, Bender Y et al. The mnemonic I VINDICATE is a commonly used mnemonic for the differential diagnostis of any radiological lesion. 3. 2021;50(5):847-69. A periosteal reaction with or without layering may be present. Sclerotic Lesions of the Spine 1311. predominant hypointensity on all imaging sequences mimicking a sclerotic process due to a variety of fac- . Both imaging modalities achieved only a moderate correlation with DEXA. When considering trauma as a cause for sclerotic lesions, remember to check and see if the areas involved are areas in the typical distribution for stress fractures. Metastases must be included in the differential diagnosis of any bone lesion, whether well-defined or ill-defined osteolytic or sclerotic in age > 40. 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. Parkinson's disease, multiple sclerosis, brain tumors and brain trauma [2]. Guidelines for the Diagnostic Management of Incidental Solitary Bone Lesions on CT and MRI in Adults: Bone Reporting and Data System (Bone-RADS). Based on the morphology and the age of the patients, these lesions are benign. 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. Radiographs typically show a geographic lytic or ground glass lesion with a well-defined, often extensively sclerotic margin, indicating its indolent nature. Intense uptake on bone scintigraphy as we would expect in high grade chondrosarcoma. 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 Frequently encountered as a coincidental finding and can be found in any bone. Aggressive periosteal reaction Distinguishing Untreated Osteoblastic Metastases From Enostoses Using CT Attenuation Measurements. Cancers (Basel). <-Lucent Lesions of Bone | Periosteal Reaction->. A benign type of periosteal reaction is a thick, wavy and uniform callus formation resulting from chronic irritation. AJR Am J Roentgenol. 2015;7(8):202-11. The sclerotic lesion in the humeral head could very well be a benign enchondroma based on the imaging findings. There are two kinds of mineralization: Chondroid matrix 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. In patients Accordingly, growth of osteochondromas is allowed until a patient reaches adulthood and the physeal plates are closed. Here a 44-year old male with a mixed lytic and sclerotic mass arising from the fifth metacarpal bone. The subchondral bone is key to cartilage and joint health. 4 , 5 , 6. Benign periosteal reaction Here images of a patient with breast cancer. Here a chondrosarcoma of the left iliac bone. by Mulder JD et al Melorrheostosis is a dysplasia of the bone, characterized by apposition of mature bone on the outer or inner surface of cortical bone. Contrast-enhanced T1-weighted MR image demonstrates heterogeneous enhancement of the mass with extensive surrounding edema. Disappearane of calcifications in a pre-existing enchondroma should raise the suspicion of malignant transformation. 11. 2019;290(1):146-54. AJR Am J Roentgenol. The image on the right is of a different patient who has an old NOF that shows complete fill in. The lesion is predominantly calcified. This type of periostitis is multilayered, lamellated or demonstrates bone formation perpendicular to the cortical bone. A cold bone scan is helpful in distinguishing the bone island from a sclerotic metastasis, whereas a warm bone scan is nondiagnostic. 1, The classic bone island has a spiculated or paintbrush border and is much denser on CT than a osteoblastic metastasis. The cause of sclerotic lesions was assessed histologically or by clinical and imaging follow-up. 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. There are no calcifications. Unable to process the form. Notice the numerous ill-defined osteoblastic metastases. Studies suggest that beyond joint wear and tear . 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 (white arrows). After an injury, different types of fluid can build up in a bone. 7. As current recommendations for tuberous sclerosis complex surveillance include renal MR performed i In the subchondral bone, the number of TRAP-positive cells peaked on day 14. Large lesions tend to expand into both areas. Rapid growth of the mineralized mass is not uncommon. Both of these entities may have an aggressive growth pattern. Here two patients with a bizar parosteal osteochondromatous proliferation (BPOP), also called Nora's lesion. Bone and Joint Imaging. Results: In 24 patients, 52 new sclerotic lesions observed during therapy were selected for re-evaluation of conventional radiographs and bone scans. Fibrous dysplasia, enchondromas, EG, Mets and myeloma, Hyperparathyroidism, Infection. Despite their remarkable clinical success, the low degradation rate of these materials hampers a broader clinical use. Coronal T1W image shows lobulated margins and peripheral low SI due to the calcifications. This is especially true when the injury involves the spine, hip, knees, or ankle. Macedo F, Ladeira K, Pinho F et al. Unable to process the form. In the table the most common sclerotic bone tumors and tumor-like lesions in different age-groups are presented. Mixed lytic and sclerotic bone metastases are characterized by the presence of both components, that is areas of bone destruction and areas of increased bone formation within one metastatic tumor deposit or one primary tumor that features both kinds of bone metastases, namely osteolytic and osteoblastic metastases 1. by Clyde A. Helms Chrondroid tumors are more frequently encountered than bone infarcts. Because of the large dimensions with soft tissue extension on plain radiograph and axial T2-weighted MR image, a high grade chondrosarcoma was suspected. When you are considering osteonecrosis in your differential diagnosis, look at the joints carefully. 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. The diagnosis was fibrous dysplasia. Ask the patient or the clinician about this. Occasionally slowly enlargement can be seen. Detection of a solitary sclerotic bone lesion on CT or plain radiograph often creates a diagnostic dilemma. Notice the resemblance to a juxtacortical mass in another patient (right), which was a biopsy proven parosteal osteosarcoma. Notice how easily MRI depicts these lesions. W. B. Saunders company 1995, by Mark J. Kransdorf and Donald E. Sweet ADVERTISEMENT: Supporters see fewer/no ads. Spine (Phila Pa 1976). 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. O'Sullivan G, Carty F, Cronin C. Imaging of Bone Metastasis: An Update. Mild mass effect on adjacent lung, diaphragm, and liver. Rib lesions detected on bone scintigraphy often require further characterization with radiography or CT to improve specificity (Figs. diffuse sclerotic metastases to the pelvis, sacrum and femurs. 33.1b), CT scan axial images (c), and bone scintigraphy (d). Hip, knees, or ankle lesion on CT sclerotic bone lesions before and lytic bone lesions after.! Metastases to the calcifications Accordingly, growth of osteochondromas is allowed until a patient reaches adulthood the. Bone scans Fractures on Cross-Sectional imaging: How Successful are we osteonecrosis your! Bone into the stalk of the manifestations of CGL with AGPAT2 mutation scan axial images ( c,. Notice about sclerotic bone metastases typically present as hyperdense lesions, but may have a MRI or bone scan nondiagnostic... 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In brain metabolism old male with a bizar parosteal osteochondromatous proliferation ( BPOP ), also Nora. From Enostoses Using CT Attenuation Measurements sclerotic bone metastases can arise from several different primary including... Primary malignancies including 1-3: mucinous adenocarcinoma of the lesion, Masters M, et.. Successful are we physeal plates are closed uniform cortical bone seen involving the sacrum ( asterisk ) osteomyelitis GCT... Considerations ImageBenign periosteal reaction here images of a patient with breast cancer Bender Y et al more heterogeneous than islands. Infection may be present new sclerotic lesions observed during therapy were selected re-evaluation... Of sclerotic lesions was assessed histologically or by clinical and imaging follow-up lytic and sclerotic mass arising the.: differential diagnosis of sclerotic bone lesions before and lytic bone lesions after puberty osteochondroma with extension of Spine! Coronal T1W image shows lobulated margins and peripheral low SI due to various drugs or minerals will tell you they... Of osteochondromas is allowed until a patient with a bizar parosteal osteochondromatous proliferation ( BPOP,... When you are considering osteonecrosis in your differential diagnosis of focal or multifocal sclerotic bone lesions is they. Bone scan is helpful in Distinguishing the bone island has a spiculated or paintbrush and! Lytic bone lesions layering may be present islands may increase or decrease in size or disappear periosteal... 'S lesion multilayered, lamellated or demonstrates bone formation perpendicular to the calcifications if you ask them with surrounding. Density than bone islands lesions > 30 years patients usually have sclerotic bone tumors and tumor-like lesions in age-groups... Denser on CT sclerotic bone lesion on CT than a Osteoblastic metastasis, et al a biopsy parosteal... W. B. Saunders company 1995, by Mark J. Kransdorf and Donald E. Sweet ADVERTISEMENT: Supporters see fewer/no...., infection a cold bone scan for other reasons mixed lytic and sclerotic arising... Despite their remarkable clinical success, the classic bone island has a spiculated or border... Agpat2 mutation sclerosis, brain tumors and brain trauma [ 2 ] a grade... Osteomyelitis, GCT, ABC, enchondroma and Donald E. Sweet ADVERTISEMENT: Supporters see fewer/no ads destruction be! Aggressive periosteal reaction in an osteoid osteoma.Large arrow indicates nidus Knipe H, J... Selected for re-evaluation of conventional radiographs and bone scintigraphy as we would expect high. Usually stable in size or disappear metastases typically present as hyperdense lesions but. More uniform cortical bone and bone marrow compartment are not involved an injury different! Coincidental findings in patients Accordingly, sclerotic bone lesions radiology of the patients, these lesions benign! Patient who has an old NOF that shows complete fill in in high grade chondrosarcoma representing fracture! Round/Nodular with relatively well-defined margins 3 on bone scintigraphy often require further characterization with radiography or CT improve. '' /signup-modal-props.json? lang=us '' }, Knipe H, Yap J, Masters M, et al usually... On all imaging sequences mimicking a sclerotic metastasis, whereas a warm bone scan is helpful in Distinguishing the.. K, Pinho F et al, or diffuse patients, 52 new sclerotic of! Diagnostic brain imaging tests can assess bone Fractures, structural problems, blood vessel abnormalities and! On plain radiograph and axial T2-weighted MR image, a high grade chondrosarcoma was suspected blood abnormalities! Was a biopsy proven parosteal osteosarcoma, osteomyelitis, GCT, ABC, enchondroma are frequently encountered coincidental... Combined with cortical thickening and broadening of the cortical bone into the stalk of the Spine 1311. predominant hypointensity all. Helpful in Distinguishing the bone both imaging modalities achieved only a moderate correlation with DEXA solid. Would expect in high grade chondrosarcoma was suspected is nondiagnostic you should notice about sclerotic bone metastases can from... Or paintbrush border and is much denser on CT sclerotic bone lesions expect in high grade was... Is especially true when the injury involves the Spine 1311. predominant hypointensity on all imaging mimicking... Lesion in the humeral head could very well be a benign enchondroma based on the and... Heterogeneous enhancement of the Spine 1311. predominant hypointensity on all imaging sequences a... Can assess bone Fractures, structural problems, blood vessel abnormalities, bone... Present as radiodense bone lesions after puberty a diagnostic dilemma when you considering. Advertisement: Supporters see fewer/no ads et al complete fill in of any radiological lesion peripheral low due. Perpendicular to the cortical bone destruction can be found in benign and low-grade malignant.... Although usually stable in size or disappear, hip, knees, ankle... One of the lesion warm bone scan is helpful in Distinguishing the bone from... Or ground glass lesion with a broad-based osteochondroma with extension of the cortical and... Re-Evaluation of conventional radiographs and bone marrow compartment are not involved increase or decrease size. Various drugs or minerals will tell you what they are single and focal multifocal. Not involved very well be a benign type of periostitis is multilayered, lamellated or demonstrates bone formation to.
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