Other benign lesions, like solitary bone cyst, fibrous dysplasia, chondroblastoma and other benign bone tumors may become inert and may also become sclerotic. However, not all epidermal inclusion cysts involve bone, and some are confined to the subcutaneous tissues. 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. Hereditary sclerosing bone dysplasias result from some disturbance in the pathways involved in osteoblast or osteoclast regulation, leading to abnormal accumulation of bone. Recommendation: No specific imaging recommendation. Rib metastases may be osteolytic, sclerotic, or mixed. Contrast-enhanced T1-weighted MR image demonstrates heterogeneous enhancement of the mass with extensive surrounding edema. This is a routine medical imaging report. CT-HU has stronger correlations with DEXA than MRI measurements. W. B. Saunders company 1995, by Mark J. Kransdorf and Donald E. Sweet Usually new bone is added to one side of the cortex only. Notice that there are small areas of ill-defined osteolysis. 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. Ossification in parosteal osteosaroma is usually more mature in the center than at the periphery. Ulano A, Bredella M, Burke P et al. Location within the skeleton The mean and maximum attenuation were measured in Hounsfield units. Multiple enchondromas and hemangiomas are seen in Maffucci's syndrome. This is an example of progression of an osteochondroma to a peripheral chondrosarcoma. Multiple myeloma is a hematologic malignancy of plasma cells that causes bone-destructive lesions and associated skeletal-related events (SREs). The differential diagnosis mostly depends on the review of the conventional radiographs and the age of the patient. These lesions usually regress spontaneously and may then become sclerotic. 8. The chondroid matrix is of a variable amount from almost absent to dens compact chondroid matrix. Click here for more detailed information about NOF. We provide care in several areas of orthopedics, such as: hand and wrist care, foot and ankle care, and joint replacement. 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. (2007) ISBN:0781765188. Bone reacts to its environment in two ways either by removing some of itself or by creating more of itself. Geode or subchondral cyst in the navicular bone, Geode or subchondral cyst in the tarsal bone, X-ray and MRI of a chondroblasoma in the tarsal bone, Chondromyxoid fibroma (CMF) in the calcaneus. Several genes have been discovered that, when disrupted, result in specific types . 2. This proved to be a reactive calcification secondary to trauma. 14. Paget disease is a chronic disorder of unknown origin with increased breakdown of bone and formation of disorganized new bone. 1991;167(9):549-52. Oncol Rev. 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. An aggressive type is seen in malignant tumors, but also in benign lesions with aggressive behavior, such as infections and eosinophilic granuloma. Focal sclerotic bony lesions (mnemonic). 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. A chondrosarcoma was diagnosed at biopsy. Notice the resemblance to a juxtacortical mass in another patient (right), which was a biopsy proven parosteal osteosarcoma. 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. Differential Diagnosis of Diffuse Sclerotic Bone Lesions. (2007) ISBN: 9780781779302 -. Cortical destruction (3) Fundamentals of Skeletal Radiology, second edition -. More uniform cortical bone destruction can be found in benign and low-grade malignant lesions. 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. Hallmark of osteosarcoma is the production of bony matrix, which is reflected by the sclerosis seen on the radiograph. SWI:low signal intensity on the inverted magnitude and phase images 9. Diffuse bony sclerosis (mnemonic). Subungual exostoses are bony projections which arise from the dorsal surface of the distal phalanx, most commonly of the hallux. Bone cyst is one of the manifestations of CGL with AGPAT2 mutation. and PD-L1 PET/CT (PD-L1 positivity is defined as having at least one lesion with radiotracer uptake over the . 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. Here CT-images of a patient with prostate cancer. Surrounded by a prominent zone of reactive sclerosis due to a periosteal and endosteal reaction, which may obscure the central nidus. Amsterdam: Elsevier; 1993. 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. Donald Resnick, Mark J. Kransdorf. 2003;415(415 Suppl):S4-13. 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 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. 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. Less common: Fibrous dysplasia, Brown tumors of hyperparathyroidism, bone infarcts. Most of the time, sclerotic lesions are benign. Mild mass effect on adjacent lung, diaphragm, and liver. Peripheral chondrosarcoma, arising from an osteochondroma (exostosis). 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), Growth of the osteochondroma takes place in the cap, corresponding with normal enchondral growth at the growth plates. 20 yo M w/ 5 cm lytic bone lesion in proximal tibia metaphysis, sharply demarcated w/ sclerotic rim. On the right T2-WI with FS of same patient.. Click here for more examples of enchondromas. SusanaBoronat, IgnasiBarber, VivekPargaonkar, JoshuaChang, Elizabeth A.Thiele . 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. Detection of a solitary sclerotic bone lesion on CT or plain radiograph often creates a diagnostic dilemma. Many sclerotic lesions in patients > 20 years are healed, previously osteolytic lesions which have ossified, such as: NOF, EG, SBC, ABC and chondroblastoma. 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. Differentiating a bone infarct from an enchondroma or low-grade chondrosarcoma on plain films can be difficult or even impossible. Teaching Point: Metastasis is the most common malignant rib lesion. AJR Am J Roentgenol. Well, generally, it means that it is due to a fairly slow-growing process. 4. Fibrous dysplasia and eosinophilic granuloma more commonly present as osteolytic lesions, but they can be sclerotic. Here an image of a patient with chronic osteomyelitis. In this chapter, we will discuss key imaging features that strongly indicate the lesion is benign and those that warn further evaluation is warranted. Bone flare phenomenon was well described on bone scans; a study 25 revealed the appearance of new or worsening bone sclerosis at 3-month CT assessment in three of 67 castration-resistant prostate cancer (CRPC) patients undergoing systemic treatment. You may have been surprised to see metastatic disease listed as a leading cause for diffuse sclerotic bones. Resonance Imaging Saeed M. Bafaraj . . The benign type is seen in benign lesions such as benign tumors and following trauma. At the periphery of the infarct a zone of relative high signal intensity on T2WI may be found. The homogeneous pattern is relatively uncommon compared to the heterogeneous pattern. 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). This image is of a 20 year old patient with a sclerotic expansile lesion in the clavicle. Enchondroma is a fairly common benign cartilaginaous lesion which may present as an entirely lytic lesion without any calcification, as a dense calcified lesion or as a mixed leson with osteolysis and calcifications. diffuse sclerotic metastases to the pelvis, sacrum and femurs. 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? Generally, this just follows common sense some lesions should logically be expected to be focal, others multifocal, and yet others diffuse or systemic. by Clyde A. Helms Generic Differential Diagnosis of Sclerotic Bone Lesions. Eosinophilic granuloma like osteomyelitis, can be a serious mimicker of malignancy (particularly Ewing sarcoma). (white arrows). Results: In 24 patients, 52 new sclerotic lesions observed during therapy were selected for re-evaluation of conventional radiographs and bone scans. Likewise patients with sclerotic lesions due to various drugs or minerals will tell you what they are taking if you ask them. Diffuse bony sclerosis (mnemonic) Last revised by Joshua Yap on 28 Jun 2022 Edit article Citation, DOI & article data A mnemonic for remembering the causes of diffuse bony sclerosis is: 3 M's PROOF Mnemonic 3 M's PROOF M: malignancy metastases ( osteoblastic metastases) lymphoma leukemia M: myelofibrosis M: mastocytosis S: sickle cell disease After an injury, different types of fluid can build up in a bone. Patients with sclerotic lesions due to metastasis often have a history of prior malignant disease. 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