1, The classic bone island has a spiculated or paintbrush border and is much denser on CT than a osteoblastic metastasis. A lucent, well-circumscribed lesion is seen with a surrounding thin sclerotic cortical rim on plain radiographs [ Figure 4 ]. Polyostotic lesions Benign lesion consisting of well-differentiated mature bone tissue within the medullary cavity. Degenerative subchondral cyst: epiphyseal, Chondroid matrix in cartilaginous tumors like enchondromas and chondrosarcomsa. 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. Chordoma is usually seen in the spine and base of the skull. The differential for multifocal lesions happens to be identical to that for focal lesions. Causes: corticosteroid use, sickle cell disease, trauma, Gaucher's disease, renal transplantation. Cortical destruction is a common finding, and not very useful in distinguishing between malignant and benign lesions. When you are considering osteonecrosis in your differential diagnosis, look at the joints carefully. Fibrous dysplasia and eosinophilic granuloma more commonly present as osteolytic lesions, but they can be sclerotic. The NK cell type is seen as a sheet of soft tissue in the nasal cavity with bone destruction and erosion without any sclerosis. Sclerotic bone metastases. Bone cyst is one of the manifestations of CGL with AGPAT2 mutation. Notice that CT depicts these lesions far better (red arrows). Many lesions can be located in both or move from the metaphysis to the diaphysis during growth. Moreover, questions such as the . I think that the best way is to start with a good differential diagnosis for sclerotic bones. 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. 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. Skeletal Radiol. Distinguishing Untreated Osteoblastic Metastases From Enostoses Using CT Attenuation Measurements. (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 ). 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. Here some typical examples of bone tumors in the foot: Fundamentals of Skeletal Radiology, second edition This shows that differentiating a tumor from a reactive proces scan be quite difficult in some cases. In some cases however the osteolytic nidus can be visible on the radiograph (figure). Here images of a patient with breast cancer. For example: Differential Diagnosis of Focal or Multifocal Sclerotic Bone Lesions. It is nost commonly located on the posterior side of the distal meta-diaphysis of the femur. Ossifications or calcifications can be present in variable amounts. Well, generally, it means that it is due to a fairly slow-growing process. Continue with the MR-images. ( A1,A2) Transversal CT of the skull of a TSC patient and . Here a lesion located in the epi- and metaphysis of the proximal humerus. Imaging is often helpful in determining a diagnosis, and it can sometimes make a particular diagnosis nearly certain. 7, Behrang Amini, Susana Calle, Octavio Arevalo, Richard M. Westmark, and Kaye D. Westmark, Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Google+ (Opens in new window), on 33 Incidental Solitary Sclerotic Bone Lesion, 27 Approach to the Solitary Vertebral Lesion on Magnetic Resonance Imaging, 28 Diffusely Abnormal Marrow Signal within the Vertebrae on MRI, Incidental Findings in Neuroimaging and Their Management, Radiology (incl. Osteoid matrix in osseus tumors like osteoid osteomas and osteosarcomas. (2007) ISBN:0781765188. AJR Am J Roentgenol. Here a chondrosarcoma of the left iliac bone. Non-ossifying fibroma (NOF) can be encoutered occasionally as a partial or completely sclerotic lesion. Prevalence of 3-5% in patients with hereditary multiple osteohondromas. Here a 44-year old male with a mixed lytic and sclerotic mass arising from the fifth metacarpal bone. This feature differentiates it from a juxtacortical tumor. 4 , 5 , 6. Sclerosis is present from either tumor new bone formation or reactive sclerosis. Clin Orthop Relat Res. 2022;51(9):1743-64. A benign type of periosteal reaction is a thick, wavy and uniform callus formation resulting from chronic irritation. 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. Fundamentals of diagnostic radiology. Bone metastases have a predilection for hematopoietic marrow sites: spine, pelvis, ribs, cranium and proximal long bones: femur, humerus. In 8 of the 24 patients, 17 of 52 new sclerotic lesions (33%) had showed positive uptake on previous bone scans. The cause of sclerotic lesions was assessed histologically or by clinical and imaging follow-up. Adamantinoma in case of a sclerotic lesion with several lucencies of the tibia in a young patient. CT of Sclerotic Bone Lesions: Imaging Features Differentiating Tuberous Sclerosis Complex with Lymphangioleiomyomatosis from Sporadic Lymphangioleiomymatosis1. Infection with a multilayered periosteal reaction. Polyostotic lesions > 30 years Generally, this just follows common sense some lesions should logically be expected to be focal, others multifocal, and yet others diffuse or systemic. AJR Am J Roentgenol. 2nd most common primary bone tumor and highly malignant. Frequently encountered as a coincidental finding and can be found in any bone. Usually one bone is involved. Most commonly originate from prostate and breast cancer and less frequently from lung cancer, lymphoma or carcinoid. Location within the skeleton Cancers (Basel). 1 When the vertebral lesion has no benign features, especially in the older adult patient, metastatic disease is always a significant consideration. 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. by Clyde A. Helms 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. None of the patients had undergone prior treatment for the metastases. Check for errors and try again. ADVERTISEMENT: Supporters see fewer/no ads. 11. 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. 2021;216(4):1022-30. 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. 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. This part corresponds to a zone of high SI on T2-WI with FS on the right. . <-Lucent Lesions of Bone | Periosteal Reaction->. Metastatic sclerotic bone lesions present in three typical patterns, focal, variegated, or diffuse based on the histological origin of the primary tumor. Acute osteomyelitis is characterised by osteolysis. Systematic Approach of Sclerotic Bone Lesions Basis on Imaging Findings. Most primary bone tumors are seen in patients In patients > 30 years we must always include metastases and myeloma in the differential diagnosis. 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). Focal sclerotic bony lesions (mnemonic). As current recommendations for tuberous sclerosis complex surveillance include renal MR performed i Cartilaginous tumors in particular chondrosarcoma may show endosteal scalloping, while a bone infarct does not. 2018;2018:1-5. In most cases of osteoid osteoma the radiographic appearance is determined by the reactive sclerosis. However, a specific density range has not been specified for those terms 1. There is a metastasis, which presents as a subtle sclerotic lesion in the humerus metaphysis. Detection of a solitary sclerotic bone lesion on CT or plain radiograph often creates a diagnostic dilemma. Usually new bone is added to one side of the cortex only. A juxtacortical chondrosarcoma has be considered in the differential diagnosis when a mineralized lesion adjacent to the cortical bone is seen. Sclerotic bone metastases can arise from several different primary malignancies including 1-3: mucinous adenocarcinoma of the gastrointestinal tract (e.g. The differential diagnosis of bone lesions that result in bony sclerosis will be given. 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. A cold bone scan is helpful in distinguishing the bone island from a sclerotic metastasis, whereas a warm bone scan is nondiagnostic. It grows primarily into the surrounding soft tissues, but may also infiltrate into the bone marrow. Arthritis Rheum., 42 (2012), pp. 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 {"url":"/signup-modal-props.json?lang=us"}, Gaillard F, Knipe H, Weerakkody Y, et al. 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), Paget disease is a chronic disorder of unknown origin with increased breakdown of bone and formation of disorganized new bone. 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