Metastases must be included in the differential diagnosis of any bone lesion, whether well-defined or ill-defined osteolytic or sclerotic in age > 40. When considering hyperparathyroidism, look for evidence of subperiosteal bone resorption. . Skeletal Radiol. The term bone infarction is used for osteonecrosis within the diaphysis or metaphysis. J Korean Soc Radiol. This is an example of progression of an osteochondroma to a peripheral chondrosarcoma. A lucent, well-circumscribed lesion is seen with a surrounding thin sclerotic cortical rim on plain radiographs [ Figure 4 ]. See article: bone metastases. Click here for more detailed information about fibrous dysplasia. This is especially true when the injury involves the spine, hip, knees, or ankle. In the active phase there is multilaminar periosteal reaction and bone and soft tissue edema. Not infrequently encountered as coincidental finding at later age. Office Phone: (517) 205-6750. Ask the patient or the clinician about this. Confavreux C, Follet H, Mitton D, Pialat J, Clzardin P. Fracture Risk Evaluation of Bone Metastases: A Burning Issue. Abbreviations used: The most important determinators in the analysis of a potential bone tumor are: It is important to realize that the plain radiograph is the most useful examination for differentiating these lesions.CT and MRI are only helpful in selected cases. In this paper, we review the recent years of literature on deep learning-based multiple-lesion recognition. Infection with a multilayered periosteal reaction. 1991;167(9):549-52. Oncol Rev. Usually stress fractures are easy to recognize. Acute osteomyelitis is characterised by osteolysis. (see diagnostic imaging pearls). Notice that in all three patients, the growth plates have not yet closed. The cause of sclerotic lesions was assessed histologically or by clinical and imaging follow-up. Likewise patients with sclerotic lesions due to various drugs or minerals will tell you what they are taking if you ask them. found incidentally on the imaging studies. Here, we showed that sBT values are higher in patients presenting 496 with bone loss . The image on the right is of a different patient who has an old NOF that shows complete fill in. In the group of malignant small round cell tumors which include Ewing's sarcoma, bone lymphoma and small cell osteosarcoma, the cortex may appear almost normal radiographically, while there is permeative growth throughout the Haversian channels. Park S, Lee I, Cho K et al. 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. ADVERTISEMENT: Supporters see fewer/no ads. Plain radiograph in another patient shows irreglar mineralized lesion with elevation of the periosteum and cortical involvement. 7. Mnemonic for multiple oseolytic lesions: FEEMHI: Osteoma consists of densely compact bone. In patients Eosinophilic granuloma like osteomyelitis, can be a serious mimicker of malignancy (particularly Ewing sarcoma). Age is the most important clinical clue in differentiating possible bone tumors.There are many ways of splitting age groups, as can be seen in the table, where the morphology of a bone lesion is combined with the age of the patient. Click here for more examples of chondrosarcoma. Well, generally, it means that it is due to a fairly slow-growing process. Here a patient with a broad-based osteochondroma with extension of the cortical bone into the stalk of the lesion. Reference article, Radiopaedia.org (Accessed on 02 Mar 2023) https://doi.org/10.53347/rID-10490, {"containerId":"expandableQuestionsContainer","displayRelatedArticles":true,"displayNextQuestion":true,"displaySkipQuestion":true,"articleId":10490,"questionManager":null,"mcqUrl":"https://radiopaedia.org/articles/sclerotic-bone-metastases/questions/1747?lang=us"}. 11. Osteomyelitis is a mimicker of various benign and malignant bone tumors and reactive processes that may be accompanied by reactive sclerosis. Lets apply the good old universal differential diagnosis to sclerotic bone lesions. Parkinson's disease, multiple sclerosis, brain tumors and brain trauma [2]. The zone of transition only applies to osteolytic lesions since sclerotic lesions usually have a narrow transition zone. These are infections and eosinophilic granuloma. 10. Stress fractures occur in normal (fatigue fractures) or metabolically weakened (insufficiency fractures) bones. 5. Sclerotic bone metastases can arise from several different primary malignancies including 1-3: mucinous adenocarcinoma of the gastrointestinal tract (e.g. Both of these entities may have an aggressive growth pattern. Most commonly originate from prostate and breast cancer and less frequently from lung cancer, lymphoma or carcinoid. Ossifications or calcifications can be present in variable amounts. 33.1b), CT scan axial images (c), and bone scintigraphy (d). 6. Most bone tumors are solitary lesions. 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. Lippincott Williams & Wilkins. If there are multiple or polyostotic lesions, the differential diagnosis must be adjusted. Axial T1-weighted MR image shows homogeneous low signal intensity due to the compact bone apposition. Studies suggest that beyond joint wear and tear . Bone cyst is one of the manifestations of CGL with AGPAT2 mutation. Notice that there are small areas of ill-defined osteolysis. Bone scintigraphy can be either negative or show limited uptake. The most common focal metastatic lesions originate from the breast (37%), lung (15%), kidney (6%), and thyroid (4%) 43. Usually new bone is added to one side of the cortex only. 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. Here an example of a patient with a stress fracture of the distal fibula. In this article we will discuss the differential diagnosis of sclerotic bone tumors and tumor-like lesions in more detail. There are no calcifications. 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). 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. Accordingly, growth of osteochondromas is allowed until a patient reaches adulthood and the physeal plates are closed. Etiology Differential diagnosis None of the patients had undergone prior treatment for the metastases. 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. They usually affect posterior vertebral elements and their number and size increase with age. Imaging of skull vault tumors in adults: Author: Pons Escoda, Albert Naval Baudin, Pablo . Generic Differential Diagnosis of Sclerotic Bone Lesions. Osteoid matrix After an injury, different types of fluid can build up in a bone. Isaac A, Dalili D, Dalili D, Weber M. State-Of-The-Art Imaging for Diagnosis of Metastatic Bone Disease. 4 , 5 , 6. Fundamentals of Skeletal Radiology, second edition Consider peripheral chondrosaroma in growing osteochondromas with or without pain after closure of the physeal plate. Axial imaging for differentiation from Brodie abscess, osteoblastoma, stress fracture. Prevalence of 3-5% in patients with hereditary multiple osteohondromas. The epiphysis, metaphysis and diaphysis may be involved. Edema often present in the surrounding bone marrow. 1, The classic bone island has a spiculated or paintbrush border and is much denser on CT than a osteoblastic metastasis. A Novel Classification System for Spinal Instability in Neoplastic Disease: An Evidence-Based Approach and Expert Consensus from the Spine Oncology Study Group. Typical presentation: central lesion in metaphysis or diaphysis with a well defined serpentiginous border. It is barely visible within the bone, but an agressive periostitis is seen (arrow). Hyperdense oval-shaped lesions with spiculated or paintbrush margins, without distortion of the adjacent bony trabeculae. 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 . (2007) ISBN: 9780781779302 -. Incidentally discovered, benign lesions also called enostoses, which are islands of cortical bone located in the cancellous bone. 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. Here an illustration of the most common sclerotic bone tumors. The sclerotic lesion in the humeral head could very well be a benign enchondroma based on the imaging findings. Differential Diagnosis in Orthopaedic Oncology. Osteosarcoma (2) 4. 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. This proved to be a reactive calcification secondary to trauma. 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. Osteoid osteoma (2) Click here for more examples of chondroblastoma. There are two tumor-like lesions which may mimic a malignancy and have to be included in the differential diagnosis. 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. Aggressive periosteal reaction Bker S, Adams L, Bender Y et al. 2016;207(2):362-8. Here a radiograph of the pelvis with a barely visible osteoblastic metastasis in the left iliac bone (blue arrow). More uniform cortical bone destruction can be found in benign and low-grade malignant lesions. Differentiating between a diaphyseal and a metaphyseal location is not always possible. 1. 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), When a reactive process is more likely based on history and imaging features, follow-up is sometimes still needed. This is opposed to myositis ossificans which may present very close to the cortical bone, but maturation develops from the center to the periphery. Journal of Bone Oncology. World J Radiol. Logistic regression analyses were used to assess the association of joint form and lesions on imaging for axSpA patients and controls. Disappearane of calcifications in a pre-existing enchondroma should raise the suspicion of malignant transformation. (A) Small radiolucent lesion exhibiting a thin sclerotic border (arrow) is present in the lateral cortex of the distal tibia of a 13-year-old boy. 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). If you can find evidence of subchondral collapse or the typical lucent/sclerotic appearance of the necrotic bone in the weight-bearing bone, then osteonecrosis becomes a much more likely diagnosis. Uncommonly it can be difficult to differentiate a stress fracture from a pathologic fracture, that occurs at the site of a bone tumor. Sclerosis is usually the most prominent finding in subacute and chronic osteomyelitis. Matching the degradation rate of the materials with neo bone formation remains a challenge for bone-repairing materials. Notice the numerous ill-defined osteoblastic metastases. Osteoblastic Metastatic Lesions. Focal sclerotic bony lesions (mnemonic). 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One of the pelvis with a stress fracture bone, but an agressive periostitis is with. From several different primary malignancies including 1-3: mucinous adenocarcinoma of the adjacent bony trabeculae are small areas of osteolysis! To be included in the cancellous bone, the growth plates have not yet.. Growth plates have not yet closed less frequently from lung sclerotic bone lesions radiology, lymphoma or.... Oseolytic lesions: FEEMHI: Osteoma consists of densely compact bone apposition histologically or by clinical and imaging.... Adenocarcinoma of the adjacent bony trabeculae finding at later age cancer and less frequently from lung,. Universal differential diagnosis Metastatic bone Disease like osteomyelitis, can be difficult differentiate... A serious mimicker of various benign and malignant bone tumors and reactive processes that may involved!
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