AJR 2000; 175:261-263. Here two patients with a bizar parosteal osteochondromatous proliferation (BPOP), also called Nora's lesion. Should be included in the differential diagnosis of young patient with multiple lucent lesions (Langerhans cell histiocytosis). One study, using a mean attenuation of 885 HU and a maximum attenuation of 1,060 HU as cut-off values, distinguished the higher density bone islands from lower density osteoblastic metastases with 95% sensitivity and 96% specificity. 2016;207(2):362-8. O'Sullivan G, Carty F, Cronin C. Imaging of Bone Metastasis: An Update. The diagnosis was fibrous dysplasia. Ulano A, Bredella M, Burke P et al. Here, we showed that sBT values are higher in patients presenting 496 with bone loss . When considering Pagets disease, it is extremely helpful to note whether there is associated bony enlargement. Arthritis Rheum., 42 (2012), pp. These are inert filled-in non-ossifying fibromas. It grows primarily into the surrounding soft tissues, but may also infiltrate into the bone marrow. These lesions were possibly misinterpreted as new when applying WHO criteria. It can also be proven histologically. Notice the lytic peripheral part with subtle calcifications. Differential Diagnosis of Diffuse Sclerotic Bone Lesions. Lippincott Williams & Wilkins. Click here for more information about bone island. When you are considering osteonecrosis in your differential diagnosis, look at the joints carefully. When considering hyperparathyroidism, look for evidence of subperiosteal bone resorption. 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. The lesion shows increased uptake of the tracer in the bone scan (arrow in Fig. A periosteal reaction with or without layering may be present. If the osteonecrosis is located in the epiphysis, the term avascular osteonecrosis is used. These are infections and eosinophilic granuloma. However, a specific density range has not been specified for those terms 1. 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. Most commonly encountered bone tumor in the small bones of the hand and foot. WSI digital slide: https://kikoxp.com/posts/4606. D'Oronzo S, Coleman R, Brown J, Silvestris F. Metastatic Bone Disease: Pathogenesis and Therapeutic Options. Society of Skeletal Radiology- White Paper. 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 . Differentiating between a diaphyseal and a metaphyseal location is not always possible. Here an example of a patient with a stress fracture of the distal fibula. Sclerotic bone lesions are commonly detected by abdominal MRI in children with tuberous sclerosis complex. Spine (Phila Pa 1976). In the subchondral bone, the number of TRAP-positive cells peaked on day 14. The homogeneous enhancement in the upper part with edema and cortical thickening are not typical for a low-grade chondrosarcoma. 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 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, Periosteal or juxtacortical chondrosarcoma, Aneurysmal Bone Cyst: Concept, Controversy, Clinical Presentation, and Imaging, Bone Tumors and Tumorlike Conditions: Analysis with Conventional Radiography. Here two other lesions in different patients that proved to be chondrosarcoma. Magnetic resonance imaging of subchondral bone marrow lesions in association with osteoarthritis. Mnemonic for multiple oseolytic lesions: FEEMHI: Differentiating a bone infarct from an enchondroma or low-grade chondrosarcoma on plain films can be difficult or even impossible. Ahuja S & Ernst H. Osteoblastic Bone Metastases in Medullary Thyroid Carcinoma. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. Home. Bker S, Adams L, Bender Y et al. Sclerosing bone dysplasias are skeletal abnormalities of varying severity with a wide range of radiologic, clinical, and genetic features. Interventional Radiology). Here some typical examples of bone tumors in the foot: Fundamentals of Skeletal Radiology, second edition 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. About Us; Staff; Camps; Scuba. However, the exact mechanism that leads to osteoblastic formation is not entirely elucidated. Yes, it is possible to have a clear lumbar puncture and still have Multiple Sclerosis (MS). 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. 4 , 5 , 6. Polyostotic lesions > 30 years Rapid growth of the mineralized mass is not uncommon. The use of radiological imaging in medical care dates back to 1895 when Bone reacts to its environment in two ways either by removing some of itself or by creating more of itself. Contrast-enhanced T1-weighted MR image demonstrates heterogeneous enhancement of the mass with extensive surrounding edema. There are calcified strands within the soft tissues. Usually stress fractures are easy to recognize. They can affect any bone and be either benign (harmless) or malignant (cancerous). 1. Skeletal Radiol. Growth of the osteochondroma takes place in the cap, corresponding with normal enchondral growth at the growth plates. As part of the test, a healthcare professional takes a sample of the CSF 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). Logistic regression analyses were used to assess the association of joint form and lesions on imaging for axSpA patients and controls. Enchondromas aswell as low-grade chondrosarcomas are frequently encountered as coincidental findings in patients who have a MRI or bone scan for other reasons. The most common focal metastatic lesions originate from the breast (37%), lung (15%), kidney (6%), and thyroid (4%) 43. Journal of Bone Oncology. Growth of osteochondroma in skeletally mature patient, Irregular or indistinct surface of lesions, focal lucent regions in interior of lesions, presence of soft tissue mass with scattered or irregular calcifications. These lesions are not osteochondromas, but consist of reactive cartilage metaplasia. Wide zone of transition It is a feature of malignant bone tumors. 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. Halo of increased signal on T2 W images about the low signal central lesion is suggestive of metastatic disease. 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. CT of Sclerotic Bone Lesions: Imaging Features Differentiating Tuberous Sclerosis Complex with Lymphangioleiomyomatosis from Sporadic Lymphangioleiomymatosis1. In this article we will discuss the differential diagnosis of sclerotic bone tumors and tumor-like lesions in more detail. Bone Metastases: An Overview. 2nd most common primary bone tumor and highly malignant. Unable to process the form. This is opposed to myositis ossificans which may present very close to the cortical bone, but maturation develops from the center to the periphery. some benign entities in this region may mimic malignancy if analyzed using classical bone-tumor criteria, and proper patient management requires being familiar with these presentations. Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. It may be spiculated and interrupted - sometimes there is a Codman's triangle. Here an incidental finding of several eccentric sclerotic lesions of the distal femur. 6. Infections and eosinophilic granulomaInfections and eosinophilic granuloma are exceptional because they are benign lesions which can mimick a malignant bone tumor due to their aggressive biologic behavior. You may have been surprised to see metastatic disease listed as a leading cause for diffuse sclerotic bones. A molecular classification has been also proposed. 11. Generally, this just follows common sense some lesions should logically be expected to be focal, others multifocal, and yet others diffuse or systemic. The major part of the lesion consists of reactive sclerosis. Materials and Methods 2003;415(415 Suppl):S4-13. Notice that there are small areas of ill-defined osteolysis. Studies suggest that beyond joint wear and tear . Therefore, MRI and bone scan were performed. 2010;35(22):E1221-9. The differential diagnosis of bone lesions that result in bony sclerosis will be given. Patients usually have sclerotic bone lesions before and lytic bone lesions after puberty. 3. Spinal lesions are commonly spotted on imaging tests. 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. The chondroid matrix is of a variable amount from almost absent to dens compact chondroid matrix. Distinguishing Untreated Osteoblastic Metastases From Enostoses Using CT Attenuation Measurements. Notice the resemblance to a juxtacortical mass in another patient (right), which was a biopsy proven parosteal osteosarcoma. Reference article, Radiopaedia.org (Accessed on 02 Mar 2023) https://doi.org/10.53347/rID-22391. Etiology Peripheral chondrosarcoma, arising from an osteochondroma (exostosis). In some cases however the osteolytic nidus can be visible on the radiograph (figure). 10. A bone island larger than 1 cm is referred to as a giant bone island (12). Axial imaging for differentiation from Brodie abscess, osteoblastoma, stress fracture. In this chapter, we will discuss key imaging features that strongly indicate the lesion is benign and those that warn further evaluation is warranted. Macedo F, Ladeira K, Pinho F et al. Recommendation: No specific imaging recommendation. (B) In another patient, a 21-year-old woman, note a radiolucent lesion with sclerotic border affecting the medial cortex of the distal femur ( arrows ). Reference article, Radiopaedia.org (Accessed on 02 Mar 2023) https://doi.org/10.53347/rID-8429. CT Other benign lesions, like solitary bone cyst, fibrous dysplasia, chondroblastoma and other benign bone tumors may become inert and may also become sclerotic. 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. Lippincott Williams & Wilkins. This could be an osteoblastic metastasis or an osteolytic metastasis that responded to chemotherapy. 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? Multiple myeloma is a hematologic malignancy of plasma cells that causes bone-destructive lesions and associated skeletal-related events (SREs). Teaching Point: Metastasis is the most common malignant rib lesion. Concerning the above factors the differential diagnosis includes the following lesions 1-3: sclerotic bone metastasis: might be solitary because no others are present or have been imaged, infection: e.g. Bone cyst is one of the manifestations of CGL with AGPAT2 mutation. A brain MRI can . 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. The MR image shows that the lesion has lobulated contours and nodular enhancement. 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. Fundamentals of diagnostic radiology. diffuse sclerotic metastases to the pelvis, sacrum and femurs. MRI of the sacrum: axial T1-weighted (T1w; Fig. Here an image of a patient with chronic osteomyelitis. Central location most common with some expansion and cortical thinning. It can identify small or large tumors, multiple sclerosis (MS), encephalitis (brain inflammation), or meningitis (inflammation of the meninges that lie between the brain and the skull). Plain radiograph and coronal T1-weighted contrast-enhanced fat-suppressed MR image of a mixed lytic and sclerotic lesion of the distal femoral diaphysis. The differential diagnosis mostly depends on the age of the patient and the findings on the conventional radiographs. There is reactive sclerosis with a nidus that is barely visible on the radiograph (blue arrow), but clearly visible on the CT (red arrows). Differential diagnosis Osteosarcoma, chondrosarcoma, and Ewing's sarcoma are the most common types of bone cancer. Bone and Joint Imaging. Coronal T1W image shows lobulated margins and peripheral low SI due to the calcifications. 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. Focal sclerotic bony lesions (mnemonic). (see diagnostic imaging pearls). Ossifications or calcifications can be present in variable amounts. The most common appearance is the mixed lytic-sclerotic. 2019;290(1):146-54. The subchondral bone is key to cartilage and joint health. 14. The mean and maximum attenuation were measured in Hounsfield units. Here are links to other articles about bone tumors: Most bone tumors are osteolytic. FD is often purely lytic, but may have a groundglass appearance as the matrix calcifies. The radiographic appearance and location are typical. Fundamentals of Skeletal Radiology, second edition by Clyde A. Helms Enhancement after i.v. Calcifications or mineralization within a bone lesion may be an important clue in the differential diagnosis. MRI also may detect the nidus, combined with abundant bone marrow and soft tissue edema. 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. If the patient had fever and a proper clinical setting, osteomyelitis would be in the differential diagnosis. W. B. Saunders company 1995, by Mark J. Kransdorf and Donald E. Sweet Radiologe. 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. Metastases are the most common malignant bone tumors. Sclerotic means that the lesions are slow-growing changes to your bone that happen very gradually over time. Radiographs typically show a geographic lytic or ground glass lesion with a well-defined, often extensively sclerotic margin, indicating its indolent nature. SWI:low signal intensity on the inverted magnitude and phase images 9. In the table the most common sclerotic bone tumors and tumor-like lesions in different age-groups are presented. 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. Fibro-osseous lesion like fibrous dysplasia. 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. 1. (white arrows). 33.1d). Localisation: femur, tibia, hands and feet, spine (arch). Differential diagnosis based on the periosteal reaction and the extensive edema: Here a patient with a juxtacortical sclerotic mass of the proximal humerus (left). The mnemonic I VINDICATE is a commonly used mnemonic for the differential diagnostis of any radiological lesion. Bone islands can be large at presentation. 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. More heterogenous and irregular with bony trabecular destruction and possible extension beyond the confines of the cortex. Confavreux C, Follet H, Mitton D, Pialat J, Clzardin P. Fracture Risk Evaluation of Bone Metastases: A Burning Issue. The differential diagnosis mostly depends on the review of the conventional radiographs and the age of the patient. Consider progression of osteohondroma to chondrosarcoma when cartilage cap measures > 10 mm. A high grade chondrosarcoma must be considered in the differential diagnosis. Distinct phenotypes are described: osteoblastic, the more common osteolytic and mixed. A periosteal chondroma may have the same imaging characteristics, however, these are almost always much smaller. Imaging of skull vault tumors in adults: Author: Pons Escoda, Albert Naval Baudin, Pablo . Accessed on 02 Mar 2023 ) https: //doi.org/10.53347/rID-8429 that proved to be chondrosarcoma a. 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