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. Mirels H. Metastatic Disease in Long Bones: A Proposed Scoring System for Diagnosing Impending Pathologic Fractures. 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. Central location most common with some expansion and cortical thinning. Less common: Fibrous dysplasia, Brown tumors of hyperparathyroidism, bone infarcts. The zone of transition only applies to osteolytic lesions since sclerotic lesions usually have a narrow transition zone. The contour of the involved bone is usually normal or with mild expansive remodelling. The term bone infarction is used for osteonecrosis within the diaphysis or metaphysis. Cortical destruction (3) mutation, and both sclerotic and lytic bone lesions together for the first time. The subchondral bone is key to cartilage and joint health. Sclerosing bone dysplasias are skeletal abnormalities of varying severity with a wide range of radiologic, clinical, and genetic features. Most commonly originate from prostate and breast cancer and less frequently from lung cancer, lymphoma or carcinoid. The differential diagnosis of bone lesions that result in bony sclerosis will be given. 2 ed. Notice the numerous ill-defined osteoblastic metastases. Bone cyst is one of the manifestations of CGL with AGPAT2 mutation. For example: Differential Diagnosis of Focal or Multifocal Sclerotic Bone Lesions. 1. DD: Ganglion cyst, osteomyelitis, GCT, ABC, enchondroma. You can then customize the above differential for whichever pattern of sclerosis that you see. Classic ground glass appearance of the bone. Journal of Bone Oncology. The diagnosis was fibrous dysplasia. This is especially true when the injury involves the spine, hip, knees, or ankle. ImageBenign periosteal reaction in an osteoid osteoma.Large arrow indicates solid periosteal reaction.Small arrow indicates nidus. Detecting a benign periosteal reaction may be very helpful, since malignant lesions never cause a benign periosteal reaction. The bone scan is also helpful to look for additional sites of increased uptake that may not have been imaged, such as multiple nontraumatic rib, calvarial, or long bone lesions, which would strongly suggest the diagnosis of metastatic disease. 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. Non-ossifying fibroma (NOF) can be encoutered occasionally as a partial or completely sclerotic lesion. 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. Resonance Imaging Saeed M. Bafaraj . The use of PET/CT imaging with new radiotracers enables a non-invasive assessment of the presence of the target of treatment in the whole body and provides the possibility to combine functional information with anatomical details. 1. At the periphery of the infarct a zone of relative high signal intensity on T2WI may be found. A periosteal reaction with or without layering may be present. These are infections and eosinophilic granuloma. You may have been surprised to see metastatic disease listed as a leading cause for diffuse sclerotic bones. 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. These lesions are not osteochondromas, but consist of reactive cartilage metaplasia. The cause of sclerotic lesions was assessed histologically or by clinical and imaging follow-up. Ossification in parosteal osteosaroma is usually more mature in the center than at the periphery. 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. Sclerotic bone lesions appear exclusively in middle aged black patients. Coronal MR image demonstrates subtle low intensity line representing the fracture. A sclerotic border especially indicates poor biological activity. Sclerotic bone lesions at abdominal magnetic resonance imaging in children with tuberous sclerosis complex. W. B. Saunders company 1995, by Mark J. Kransdorf and Donald E. Sweet 2nd most common primary bone tumor and highly malignant. Multiple enchondromas and hemangiomas are seen in Maffucci's syndrome. This image is of a 20 year old patient with a sclerotic expansile lesion in the clavicle. Brant WE, Helms CA. Here a chondrosarcoma of the left iliac bone. 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). Benign lesion consisting of well-differentiated mature bone tissue within the medullary cavity. Brant WE, Helms CA. The MR image shows that the lesion has lobulated contours and nodular enhancement. 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. 105-118. Disappearane of calcifications in a pre-existing enchondroma should raise the suspicion of malignant transformation. When you are considering osteonecrosis in your differential diagnosis, look at the joints carefully. 1 When the vertebral lesion has no benign features, especially in the older adult patient, metastatic disease is always a significant consideration. As part of the test, a healthcare professional takes a sample of the CSF Acute osteomyelitis is characterised by osteolysis. Here Melorrheostosis of the ulna with the appearance of candle wax. For those that are possibly cancerous, a biopsy is conducted to identify it. Infection may be well-defined or ill-defined osteolytic, and even sclerotic. Bone scan shows no high activity, opposed to low-grade intraosseous osteosarcoma. Non-ossifying fibroma which has been filled in. Development in centrally located osteochondromas like the pelvis, hip and shoulder is most common. Bone scintigraphy (99mTc MDP) is very sensitive for the detection of osteoblastic providing information on osteoblastic activity but suffers from specificity with a false-positivity rate ranging up to 40% 1. In Section 2, we give the general technical route for classification, detection and segmentation of multiple-lesion.After that, in Section 3, the paper will review the recognition of multiple-lesion in six organ and tissue areas, including brain, eye, skin, breast, lung, and abdomen. 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). If the disorder it is reacting to is rapidly progressive, there may only be time for retreat (defense). (2007) ISBN:0781765188. 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. Fibro-osseous lesion like fibrous dysplasia. . brae in keeping with diffuse bone infarcts. Here an illustration of the most common sclerotic bone tumors. The chondroid matrix is of a variable amount from almost absent to dens compact chondroid matrix. 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. Likewise patients with sclerotic lesions due to various drugs or minerals will tell you what they are taking if you ask them. Radiographs are specific but suffer from low sensitivity 1. At the 1-year follow-up, the lesion was completely stable and no additional follow-up was recommended in the absence of symptoms. 13. Amorphous mineralisation is present in most lesions. Chrondroid tumors are more frequently encountered than bone infarcts. 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. Here on a radiograph the typical calcifications in the chondroid matrix of an enchondroma. Rib lesions detected on bone scintigraphy often require further characterization with radiography or CT to improve specificity (Figs. 4 , 5 , 6. Plain films typically reveal lesions with moth-eaten or permeative pattern of the transition zone with irregular cortical destruction and an interrupted periosteal reaction with soft tissue extension. However, not all epidermal inclusion cysts involve bone, and some are confined to the subcutaneous tissues. A brain MRI can . Impact of Sclerotic. Many important signaling . Bone metastases have a predilection for hematopoietic marrow sites: spine, pelvis, ribs, cranium and proximal long bones: femur, humerus. A bone island larger than 1 cm is referred to as a giant bone island (12). This is a routine medical imaging report. Osteoblastic Metastatic Lesions. In some cases however the osteolytic nidus can be visible on the radiograph (figure). Reference article, Radiopaedia.org (Accessed on 02 Mar 2023) https://doi.org/10.53347/rID-21100, Mnemonic for focal sclerotic lesions (mnemonic). Differentiating between a diaphyseal and a metaphyseal location is not always possible. AJR 2005; 185:915-924. 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. Strahlenther Onkol. Click here for more examples of chondroblastoma. Secondary bone cancer is much more common than primary bone . . In this article we will discuss the differential diagnosis of sclerotic bone tumors and tumor-like lesions in more detail. Etiology Isaac A, Dalili D, Dalili D, Weber M. State-Of-The-Art Imaging for Diagnosis of Metastatic Bone Disease. 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. In this article we will discuss a systematic approach to the differential diagnosis of bone tumors and tumor-like lesions. Radiographs typically show a geographic lytic or ground glass lesion with a well-defined, often extensively sclerotic margin, indicating its indolent nature. Click here for more detailed information about fibrous dysplasia. Guidelines for the Diagnostic Management of Incidental Solitary Bone Lesions on CT and MRI in Adults: Bone Reporting and Data System (Bone-RADS). Ulano A, Bredella M, Burke P et al. In the epiphysis we use the term avascular necrosis and not bone infarction. Another finding classic for Pagets disease is that it almost always starts at one end of a bone and then spreads toward the other end of the bone. In 8 of the 24 patients, 17 of 52 new sclerotic lesions (33%) had showed positive uptake on previous bone scans. Unable to process the form. Bone metastases start with the tropism of cancer cells to the bone through different multi-step tumor-host interactions, as described by the . Publicationdate 2010-04-10 / update 2022-03-17. MRI also may detect the nidus, combined with abundant bone marrow and soft tissue edema. The X-ray features were divided into two groups according to typical and atypical skeletal lesions. A high grade chondrosarcoma must be considered in the differential diagnosis. SusanaBoronat, IgnasiBarber, VivekPargaonkar, JoshuaChang, Elizabeth A.Thiele . 2020;60(Suppl 1):1-16. 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