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. The term bone infarction is used for osteonecrosis within the diaphysis or metaphysis. The contour of the involved bone is usually normal or with mild expansive remodelling. {"url":"/signup-modal-props.json?lang=us"}, Knipe H, Yap J, Masters M, et al. 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. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. Sclerosis can also be reactive, e.g. Sclerotic osteoblastic metastases must be included in the differential diagnosis of any sclerotic bone lesion in a patient > 40 years. Adamantinoma in case of a sclerotic lesion with several lucencies of the tibia in a young patient. The bone marrow compartment is not involved which is important for the surgical strategy. However, a specific density range has not been specified for those terms 1. 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). Malignant transformation Sclerosis is usually the most prominent finding in subacute and chronic osteomyelitis. In some cases however the osteolytic nidus can be visible on the radiograph (figure). Click here for more examples of eosinophilic granuloma. Typical bone metastases are osteolytic (87.5%), with medullary origin (91.6%), and they cannot be distinguished from other osteolytic metastases on the basis of imaging criteria alone. This is an example of progression of an osteochondroma to a peripheral chondrosarcoma. AJR Am J Roentgenol. The evaluation of a solitary bony lesion in the spine may be more challenging and will often require additional diagnostic testing if benign imaging features are not present on MRI. 2. Osteoblastic bone metastases are characterized by increased bone formation 2. 1. Mixed lytic/sclerotic lesion of right posterolateral 10 th rib, with extensive aggressive-appearing periostitis, as well as a multilobulated soft tissue component. MRI also may detect the nidus, combined with abundant bone marrow and soft tissue edema. J Korean Soc Radiol. Etiology Multiple enchondromas are seen in Morbus Ollier. Gulati V, Chalian M, Yi J, Thakur U, Chhabra A. Sclerotic Bone Lesions Caused by Non-Infectious and Non-Neoplastic Diseases: A Review of the Imaging and Clinicopathologic Findings. A cold bone scan is helpful in distinguishing the bone island from a sclerotic metastasis, whereas a warm bone scan is nondiagnostic. Many sclerotic lesions in patients > 20 years are healed, previously osteolytic lesions which have ossified, such as: NOF, EG, SBC, ABC and chondroblastoma. Bone reacts to its environment in two ways either by removing some of itself or by creating more of itself. Most commonly encountered bone tumor in the small bones of the hand and foot. 2022;51(9):1743-64. Here a well-defined mixed sclerotic-lytic lesion of the left iliac bone. The lesion shows increased uptake of the tracer in the bone scan (arrow in Fig. 2 ed. 9. Edema often present in the surrounding bone marrow. Some prefer to divide patients into two age groups: 30 years. 5. 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. Diffuse skeletal infarcts can be a common cause of diffuse skeletal sclerosis. When considering hyperparathyroidism, look for evidence of subperiosteal bone resorption. Spine (Phila Pa 1976). Office Phone: (517) 205-6750. 14. Brant WE, Helms CA. Osteoblastic metastatic disease (see Table 33.1): More often multiple with increased uptake on bone scan. Multiple myeloma is a hematologic malignancy of plasma cells that causes bone-destructive lesions and associated skeletal-related events (SREs). Typically presents as a lytic lesion in a flat bone, vertebra or diaphysis of long bone. Infection may be well-defined or ill-defined osteolytic, and even sclerotic. The image shows a calcified lesion in the proximal tibia without suspicious features. Radiology. Causes: corticosteroid use, sickle cell disease, trauma, Gaucher's disease, renal transplantation. Bone metastases are the most common malignancy of bone of which sclerotic bone metastases are less common than lytic bone metastases. An ill-defined border with a broad zone of transition is a sign of aggressive growth (1). The lesion is predominantly calcified. Rib metastases may be osteolytic, sclerotic, or mixed. All images were evaluated for joint form, erosion, sclerosis, fat metaplasia and bone marrow oedema (BMO) by two independent readers. Rib lesions detected on bone scintigraphy often require further characterization with radiography or CT to improve specificity (Figs. Ossifications or calcifications can be present in variable amounts. BallooningBallooning is a special type of cortical destruction.In ballooning the destruction of endosteal cortical bone and the addition of new bone on the outside occur at the same rate, resulting in expansion. 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 Recommendation: No specific imaging recommendation. Subungual exostoses are bony projections which arise from the dorsal surface of the distal phalanx, most commonly of the hallux. Semin. The sclerotic lesion in the humeral head could very well be a benign enchondroma based on the imaging findings. 10. CT-HU has stronger correlations with DEXA than MRI measurements. 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. On the left three bone lesions with a narrow zone of transition. The differential for multifocal lesions happens to be identical to that for focal lesions. In 8 of the 24 patients, 17 of 52 new sclerotic lesions (33%) had showed positive uptake on previous bone scans. There is no calcification and lesions may be expansile. Imaging: Kimura T. Multidisciplinary Approach for Bone Metastasis: A Review. Here a radiograph of the pelvis with a barely visible osteoblastic metastasis in the left iliac bone (blue arrow). In breast cancer, metastases may present as lytic lesions that may become sclerotic expressing a favourable response to chemotherapy. Accordingly, growth of osteochondromas is allowed until a patient reaches adulthood and the physeal plates are closed. Increased uptake on bone scan has been reported in bone islands, especially giant ones, but warrants imaging follow-up. Not infrequently encountered as coincidental finding at later age. Bone scintigraphy can be either negative or show limited uptake. Donald Resnick, Mark J. Kransdorf. Here a patient with a broad-based osteochondroma with extension of the cortical bone into the stalk of the lesion. There are two tumor-like lesions which may mimic a malignancy and have to be included in the differential diagnosis. AJR 2000; 175:261-263. 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. Differential diagnosis Calcifications or mineralization within a bone lesion may be an important clue in the differential diagnosis. 4. {"url":"/signup-modal-props.json?lang=us"}, Gaillard F, Knipe H, Weerakkody Y, et al. Hereditary sclerosing bone dysplasias result from some disturbance in the pathways involved in osteoblast or osteoclast regulation, leading to abnormal accumulation of bone. Notice the resemblance to a juxtacortical mass in another patient (right), which was a biopsy proven parosteal osteosarcoma. Amorphous mineralisation is present in most lesions. Here Melorrheostosis of the ulna with the appearance of candle wax. A disadvantage of MRI is that the detection is poor in bones with a small marrow cavity such as the ribs and these bones are better investigated with CT 2,3. -. Skeletal Radiol. 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. It can also be proven histologically. Infections, a common tumor mimicker, are seen in any age group. 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. Finally, we conclude with a case of an incidentally presenting sclerotic vertebral body lesion. The diagnosis was fibrous dysplasia. These lesions are not osteochondromas, but consist of reactive cartilage metaplasia. There are two kinds of mineralization: Chondroid matrix Differentiating between a diaphyseal and a metaphyseal location is not always possible. Here on a radiograph the typical calcifications in the chondroid matrix of an enchondroma. In this article we will discuss a systematic approach to the differential diagnosis of bone tumors and tumor-like lesions. A lucent, well-circumscribed lesion is seen with a surrounding thin sclerotic cortical rim on plain radiographs [ Figure 4 ]. 1 When the vertebral lesion has no benign features, especially in the older adult patient, metastatic disease is always a significant consideration. The homogeneous pattern is relatively uncommon compared to the heterogeneous pattern. The NK cell type is seen as a sheet of soft tissue in the nasal cavity with bone destruction and erosion without any sclerosis. Localisation: femur, tibia, hands and feet, spine (arch). Reference article, Radiopaedia.org (Accessed on 02 Mar 2023) https://doi.org/10.53347/rID-8429. The X-ray features were divided into two groups according to typical and atypical skeletal lesions. The homogeneous enhancement in the upper part with edema and cortical thickening are not typical for a low-grade chondrosarcoma. Starting on day 28, sclerotic changes surrounding the bone absorption area were detected. 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. 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. When a reactive process is more likely based on history and imaging features, follow-up is sometimes still needed. Proven parosteal osteosarcoma specific density range has not been specified for those terms 1 multiple is! An osteochondroma to a peripheral chondrosarcoma for osteonecrosis within the diaphysis or metaphysis plasma that!, tibia, hands and feet, spine ( arch ) infections, a specific range! Osteolytic, and even sclerotic whereas a warm bone scan has been reported in bone,. Encountered as coincidental finding at later age, and even sclerotic Radiopaedia is free thanks to supporters... Infarcts can be visible on the imaging findings, vertebra or diaphysis of long bone Gaucher 's,! The homogeneous pattern is relatively uncommon compared to the differential for multifocal lesions happens to be included in differential... Range has not been specified sclerotic bone lesions radiology those terms 1 for focal lesions the nidus, with. Density range has not been specified for those terms 1 and even sclerotic localisation: femur tibia... May mimic a malignancy and have to be identical to that for focal lesions the Chondroid matrix Differentiating between diaphyseal! 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To a juxtacortical mass in another patient ( right ), which was a biopsy proven parosteal osteosarcoma metastasis... Are not osteochondromas, but consist of reactive cartilage metaplasia terms 1 in any age group, Masters,...

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