As you can see, by just dropping the items that tend to cause generalized sclerosis, we have generated a fairly good differential for focal lesions. Ossifications or calcifications can be present in variable amounts. There is a metastasis, which presents as a subtle sclerotic lesion in the humerus metaphysis. Notice the lytic peripheral part with subtle calcifications. T2-weighted axial MR image demonstrates high signal intensity of the tumor in the metacarpal bone with extension of a lobulated soft tissue mass. Lippincott Williams & Wilkins. by Clyde A. Helms and PD-L1 PET/CT (PD-L1 positivity is defined as having at least one lesion with radiotracer uptake over the . Many lesions can be located in both or move from the metaphysis to the diaphysis during growth. Here an illustration of the most common sclerotic bone tumors. Centrally there is an ill-defined osteolytic area. Notice that the mineralization is predominantly in the periphery of the mass and that there is a lucent zone between the mass and the cortical bone. Differentiating between a diaphyseal and a metaphyseal location is not always possible. The use of radiological imaging in medical care dates back to 1895 when Here a lesion in the epiphysis, which was the result of post-traumatic osteonecrosis. W. B. Saunders company 1995, by Mark J. Kransdorf and Donald E. Sweet 5. The benign type is seen in benign lesions such as benign tumors and following trauma. Copyright 2023 University of Washington | All rights reserved, Pilot PET Radiotracer and Imaging Awards for Grant Applications, Diagnostic and Interventional Radiology Interest Group, Charles A. Rohrmann, Jr., M.D., Endowment for Radiology Resident Educational Excellence, Michael and Rebecca McGoodwin Endowment for Radiology Resident and Fellow Training and Education, The Norman and Anne Beauchamp Endowed Fund for Radiology. In this case, because of the increased uptake on bone scintigraphy, a follow-up MRI was recommended at 6 and 12 months. Most bone tumors are solitary lesions. In fact, in areas where sickle cell disease is common, this may be the leading cause of diffuse sclerotic bones. NOF, fibrous dysplasia, multifocal osteomyelitis, enchondromas, osteochondoma, leukemia and metastatic Ewing' s sarcoma. Here two patients with a bizar parosteal osteochondromatous proliferation (BPOP), also called Nora's lesion. 2020;60(Suppl 1):1-16. In the late stage of OA, the main feature is subchondral bone sclerosis, whose microarchitectural characteristics are elevated apparent density, increased bone volume, . Contact Information and Hours. These are inert filled-in non-ossifying fibromas. CT scan is usually very helpful in detecting the nidus and differentiating osteoid osteoma from other sclerotic lesions like osteoblastoma, osteomyelitis, arthritis, stress fracture and enostosis. Plain radiograph in another patient shows irreglar mineralized lesion with elevation of the periosteum and cortical involvement. Multiple myeloma is a hematologic malignancy of plasma cells that causes bone-destructive lesions and associated skeletal-related events (SREs). Detecting a benign periosteal reaction may be very helpful, since malignant lesions never cause a benign periosteal reaction. However, a specific density range has not been specified for those terms 1. In order to classify osteolytic lesions as well-defined or ill-defined, we need to look at the zone of transition between the lesion and the adjacent normal bone. 8. Metastases are the most common malignant bone tumors. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. 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. in Ewing's sarcoma or lymphoma. Incidentally discovered, benign lesions also called enostoses, which are islands of cortical bone located in the cancellous bone. Notice the resemblance to a juxtacortical mass in another patient (right), which was a biopsy proven parosteal osteosarcoma. 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. Prevalence of 3-5% in patients with hereditary multiple osteohondromas. What does it mean that a lesion is sclerotic? Focal sclerotic bony lesions (mnemonic). Well, generally, it means that it is due to a fairly slow-growing process. Mixed lytic/sclerotic lesion of right posterolateral 10 th rib, with extensive aggressive-appearing periostitis, as well as a multilobulated soft tissue component. Here on a radiograph the typical calcifications in the chondroid matrix of an enchondroma. Osteosarcoma (2) Sclerotic bone lesions at abdominal magnetic resonance imaging in children with tuberous sclerosis complex. Another approach to the differential diagnosis of sclerotic bone lesions is to use the mnemonic I VINDICATE, which means 'I clear myself from accusation'. 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. . Notice the numerous ill-defined osteoblastic metastases. This occurs in early knee osteoarthritis and indicates the potential for cartilage loss and misalignment of a knee compartment. Should be included in the differential diagnosis of young patient with multiple lucent lesions (Langerhans cell histiocytosis). Most of the time, sclerotic lesions are benign. These lesions are not osteochondromas, but consist of reactive cartilage metaplasia. Plain radiograph and coronal T1-weighted contrast-enhanced fat-suppressed MR image of a mixed lytic and sclerotic lesion of the distal femoral diaphysis. Sclerotic means that the lesions are slow-growing changes to your bone that happen very gradually over time. Cancers (Basel). A periosteal chondroma may have the same imaging characteristics, however, these are almost always much smaller. Continue with the MR-images. Sarcoidosis is a multi-system disease with a range of . Click here for more detailed information about NOF. Sclerotic bone lesions appear exclusively in middle aged black patients. The image on the right is of a different patient who has an old NOF that shows complete fill in. 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. Osteosarcoma, chondrosarcoma, and Ewing's sarcoma are the most common types of bone cancer. 6. 5 Biopsy should be considered in atypical cases or in high-risk patients with primary malignancies associated with osteoblastic metastatic disease. Materials and Methods A bone island larger than 1 cm is referred to as a giant bone island (12). Spinal lesions are commonly spotted on imaging tests. Localisation: femur, tibia, hands and feet, spine (arch). Coronal T1W image shows lobulated margins and peripheral low SI due to the calcifications. It is most commonly located in the outer table of the neurocranium or in a paranasal sinus. 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), Subungual exostoses are bony projections which arise from the dorsal surface of the distal phalanx, most commonly of the hallux. 2. Osteomyelitis is a mimicker of various benign and malignant bone tumors and reactive processes that may be accompanied by reactive sclerosis. Causes: corticosteroid use, sickle cell disease, trauma, Gaucher's disease, renal transplantation. A surface osteosarcoma could be considered in the differential diagnosis. The chondroid matrix is of a variable amount from almost absent to dens compact chondroid matrix. Coronal MR image demonstrates subtle low intensity line representing the fracture. Results: In 24 patients, 52 new sclerotic lesions observed during therapy were selected for re-evaluation of conventional radiographs and bone scans. It is true that the usual appearance of skeletal metastases is that of focal lesions diffuse sclerosis occurs in only a small fraction of cases of skeletal metastases. Bone and Joint Imaging. Osteoblastic metastatic disease (see Table 33.1): More often multiple with increased uptake on bone scan. Osteosarcoma with interrupted periosteal rection and Codman's triangle proximally (red arrow). Both imaging modalities achieved only a moderate correlation with DEXA. Mnemonic for multiple oseolytic lesions: FEEMHI: Sclerotic bone metastases. As part of the test, a healthcare professional takes a sample of the CSF Imaging: Bone marrow edema can happen with fractures and other serious bone or joint injuries. They usually affect posterior vertebral elements and their number and size increase with age. Metastatic sclerotic bone lesions present in three typical patterns, focal, variegated, or diffuse based on the histological origin of the primary tumor. Classic ground glass appearance of the bone. Differential diagnosis Sclerotic jaw lesions are not rare and are frequently encountered on radiographs and computed tomography (CT). Ewing sarcoma with lamellated and focally interrupted periosteal reaction. DD: Ganglion cyst, osteomyelitis, GCT, ABC, enchondroma. We provide care in several areas of orthopedics, such as: hand and wrist care, foot and ankle care, and joint replacement. W. B. Saunders company 1995, by Mark J. Kransdorf and Donald E. Sweet 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. 33.1b), CT scan axial images (c), and bone scintigraphy (d). 2. A Novel Classification System for Spinal Instability in Neoplastic Disease: An Evidence-Based Approach and Expert Consensus from the Spine Oncology Study Group. Here images of a patient with prostate cancer. 2021;13(22):5711. The image shows a calcified lesion in the proximal tibia without suspicious features. Here are links to other articles about bone tumors: Most bone tumors are osteolytic. Differential diagnosis based on the periosteal reaction and the extensive edema: Here a patient with a juxtacortical sclerotic mass of the proximal humerus (left). Ask the patient or the clinician about this. 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. 2021;216(4):1022-30. Hall F & Gore S. Osteosclerotic Myeloma Variants. For example: Differential Diagnosis of Focal or Multifocal Sclerotic Bone Lesions. Interventional Radiology). (see diagnostic imaging pearls). {"url":"/signup-modal-props.json?lang=us"}, Gaillard F, Knipe H, Weerakkody Y, et al. Parkinson's disease, multiple sclerosis, brain tumors and brain trauma [2]. 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). Ulano A, Bredella M, Burke P et al. Signed by [redacted] on 1/17/2020 11:42 AM Narrative 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. Clin Orthop Relat Res. Here images of an osteosarcoma in the right femur. Clinically relevant bone metastases are a major cause of morbidity and mortality for prostate cancer patients. Yes, it is possible to have a clear lumbar puncture and still have Multiple Sclerosis (MS). Osteoid matrix in osseus tumors like osteoid osteomas and osteosarcomas. 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. Urgency: Routine. A molecular classification has been also proposed. Imaging of skull vault tumors in adults: Author: Pons Escoda, Albert Naval Baudin, Pablo . Hallmark of osteosarcoma is the production of bony matrix, which is reflected by the sclerosis seen on the radiograph. 7A, and 7B ). In the case of benign, slowly growing lesions, the periosteum has time to lay down thick new bone and remodel it into a more normal-appearing cortex. Distinguishing Untreated Osteoblastic Metastases From Enostoses Using CT Attenuation Measurements. For those that are possibly cancerous, a biopsy is conducted to identify it. Isaac A, Dalili D, Dalili D, Weber M. State-Of-The-Art Imaging for Diagnosis of Metastatic Bone Disease. A sclerotic border especially indicates poor biological activity. 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? 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. The location of a bone lesion within the skeleton can be a clue in the differential diagnosis. 5, In the cases with no known primary malignancy that are being followed with serial imaging, if the lesion increases in diameter by greater than 25% at 6 months or less, or greater than 50% at 12 months, open biopsy has been recommended by Brien et al. Because of the large dimensions with soft tissue extension on plain radiograph and axial T2-weighted MR image, a high grade chondrosarcoma was suspected. 10. Uncommonly it can be difficult to differentiate a stress fracture from a bone tumor like an osteoid osteoma or from a pathologic fracture, that occurs at the site of a bone tumor. 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. Surrounded by a prominent zone of reactive sclerosis due to a periosteal and endosteal reaction, which may obscure the central nidus. Infection is seen in all ages. 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. It can differentiate predominantly osteoblastic from osteolytic bone metastases 9 as well as easily demonstrate and assess complications such as pathological fractures or spinal cord compression 2,3. Mass displaces and involves both the right 10 th intercostal artery, as well as more superior right 9 th intercostal artery. The sclerotic lesion in the humeral head could very well be a benign enchondroma based on the imaging findings. World J Radiol. Location within the skeleton The differential diagnosis of solitary sclerotic bone lesions can be narrowed down according to the following factors 1-3: cartilaginous matrix (rings and arcs appearance). Bone scintigraphy can be either negative or show limited uptake. A brain MRI can . Brant WE, Helms CA. This part corresponds to a zone of high SI on T2-WI with FS on the right. 2022;51(9):1743-64. Cortical destruction is a common finding, and not very useful in distinguishing between malignant and benign lesions. 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. The lesson here is that when we are dealing with a very common disorder, even its less common presentations will be seen commonly. 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. Bone reacts to its environment in two ways either by removing some of itself or by creating more of itself. The mnemonic I VINDICATE is a commonly used mnemonic for the differential diagnostis of any radiological lesion. Wayne State University, Orthopaedic Surgery, MI, 2007 University of Texas Southwestern Medical School, Surgery, TX, 2002 2018;10(6):156. 2018;2018:1-5. Here a lesion located in the epi- and metaphysis of the proximal humerus. Detection of a solitary sclerotic bone lesion on CT or plain radiograph often creates a diagnostic dilemma. Bone reacts to its environment in two ways either by removing some of itself or by creating more of itself. Radiographic features that should raise the suspicion of malignant transformation on plain radiographs or CT include: Here the reactive sclerosis is the most obvious finding on the X-ray. {"url":"/signup-modal-props.json?lang=us"}, Yap K, Knipe H, Niknejad M, et al. The cause of sclerotic lesions was assessed histologically or by clinical and imaging follow-up. Click here for more detailed information about fibrous dysplasia. Teaching Point: Metastasis is the most common malignant rib lesion. Adamantinoma in case of a sclerotic lesion with several lucencies of the tibia in a young patient. 2021;50(5):847-69. This is an example of progression of an osteochondroma to a peripheral chondrosarcoma. SusanaBoronat, IgnasiBarber, VivekPargaonkar, JoshuaChang, Elizabeth A.Thiele . Here a well-defined mixed sclerotic-lytic lesion of the left iliac bone. Notice the homogeneous thickening of the cortical bone. The zone of transition only applies to osteolytic lesions since sclerotic lesions usually have a narrow transition zone. 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. In this article we will discuss a systematic approach to the differential diagnosis of bone tumors and tumor-like lesions. Several genes have been discovered that, when disrupted, result in specific types . In some cases however the osteolytic nidus can be visible on the radiograph (figure). Mineralization in osteoid tumors can be described as a trabecular ossification pattern in benign bone-forming lesions and as a cloud-like or ill-defined amorphous pattern in osteosarcomas. 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. 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, Location: epiphysis - metaphysis - diaphysis, Location: centric - eccentric - juxtacortical, Aneurysmal Bone Cyst: Concept, Controversy, Clinical Presentation, and Imaging, Bone Tumors and Tumorlike Conditions: Analysis with Conventional Radiography, The 'Mini Brain' Plasmacytoma in a Vertebral Body on MR Imaging, HPT = Hyperparathyroidism with Brown tumor, The morphology of the bone lesion on a plain radiograph. Metastases must be included in the differential diagnosis of any bone lesion, whether well-defined or ill-defined osteolytic or sclerotic in age > 40. It can also be proven histologically. It is a feature of malignant bone tumors. ImageBenign periosteal reaction in an osteoid osteoma.Large arrow indicates solid periosteal reaction.Small arrow indicates nidus. 3. <-Lucent Lesions of Bone | Periosteal Reaction->. DD: old SBC. The differential for multifocal lesions happens to be identical to that for focal lesions. Many important signaling . Sclerosing bone dysplasias are skeletal abnormalities of varying severity with a wide range of radiologic, clinical, and genetic features. Regarding bone disease in SM, increased sBT levels have been 493 associated with both bone sclerosis (due to unknown mechanisms) (8, 18, 19) and 494 osteoporosis (it has been hypothesized that tryptase could induce the production of 495 OPG (61)) (4, 17). Adam Greenspan, Gernot Jundt, Wolfgang Remagen. Less dense on CT and more heterogeneous than bone islands. Usually stress fractures are easy to recognize. Other benign lesions, like solitary bone cyst, fibrous dysplasia, chondroblastoma and other benign bone tumors may become inert and may also become sclerotic. Symptoms include pain, abnormal sensations, loss of motor skills or coordination, or the loss of certain bodily functions. An ill-defined border with a broad zone of transition is a sign of aggressive growth (1). The bone scan is also helpful to look for additional sites of increased uptake that may not have been imaged, such as multiple nontraumatic rib, calvarial, or long bone lesions, which would strongly suggest the diagnosis of metastatic disease. 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. Notice that there are small areas of ill-defined osteolysis. Moreover, questions such as the . 12. 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. In this article we will discuss the differential diagnosis of sclerotic bone tumors and tumor-like lesions in more detail. Fibrous dysplasia can be monostotic or polyostotic. Impact of Sclerotic. 13. CT-HU has stronger correlations with DEXA than MRI measurements. A juxtacortical chondrosarcoma has be considered in the differential diagnosis when a mineralized lesion adjacent to the cortical bone is seen. If the osteonecrosis is located in the epiphysis, the term avascular osteonecrosis is used. Fibrous dysplasia and eosinophilic granuloma more commonly present as osteolytic lesions, but they can be sclerotic. 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. The cortical bone and bone marrow compartment are not involved. Growth has been demonstrated well after skeletal maturity. Sclerotic bone lesions as a potential imaging biomarker for the diagnosis of tuberous sclerosis complex Authors Susanne Brakemeier 1 , Lars Vogt 2 , Lisa C Adams 2 , Bianca Zukunft 3 , Gerd Diederichs 2 , Bernd Hamm 2 , Klemens Budde 3 , Kai-Uwe Eckardt 3 , Marcus R Makowski 2 4 Affiliations 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"}. 2019;290(1):146-54. The differential diagnosis of bone lesions that result in bony sclerosis will be given. Ali Mohammed Hammamy R, Farooqui K, Ghadban W. Sclerotic Bone Metastasis in Pulmonary Adenocarcinoma. Arthritis Rheum., 42 (2012), pp. The role of imaging in SN lymphomas is to identify the primary site of disease, site for biopsy and to map the lesion in its entirety in cases of patients undergoing radiotherapy [ 15, 21 ]. The sclerotic lesion in the humeral head could very well be a benign enchondroma based on the imaging findings. 1. 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. A cold bone scan is helpful in distinguishing the bone island from a sclerotic metastasis, whereas a warm bone scan is nondiagnostic. Click here for more examples of enchondromas. This is especially true when the injury involves the spine, hip, knees, or ankle. This type of periostitis is multilayered, lamellated or demonstrates bone formation perpendicular to the cortical bone. Benign periosteal reaction 2. On the right T2-WI with FS of same patient.. When considering hyperparathyroidism, look for evidence of subperiosteal bone resorption. Here two other lesions in different patients that proved to be chondrosarcoma. 1, The classic bone island has a spiculated or paintbrush border and is much denser on CT than a osteoblastic metastasis. Differentiating a bone infarct from an enchondroma or low-grade chondrosarcoma on plain films can be difficult or even impossible. After an injury, different types of fluid can build up in a bone. If the disorder it is reacting to is rapidly progressive, there may only be time for retreat (defense). There is no calcification and lesions may be expansile. Growth of osteochondromas at adult ages, which is characterized by a thick cartilaginous cap (high SI on T2WI) should raise the suspicion of progression to a peripheral chondrosarcoma. Contrast-enhanced T1-weighted MR image demonstrates heterogeneous enhancement of the mass with extensive surrounding edema. These lesions may have ill-defined margins, but cortical destruction and an aggressive type of periosteal reaction may also be seen. Sclerotic bone lesions are rare; commonly affects the axial skeleton (pelvis, spine, skull, ribs) and the patients are often symptomatic as opposed to the patients with lytic lesions who rarely have any symptoms. Bone Metastases: An Overview. Lumbar CT-HU has the highest pooled correlation (r 2 =0.6) with both spine DEXA and lowest skeletal t-score followed by lumbar CT-HU with hip DEXA (r 2 =0.5) and lumbar MRI with hip (r 2 =0.44) and spine (r 2 =0.41) DEXA. Lesions in the bone are usually identified on radiographic images - chiefly X-rays - but also on CT and MRI scans. It grows primarily into the surrounding soft tissues, but may also infiltrate into the bone marrow. Edema often present in the surrounding bone marrow. (2005) ISBN: 9780721602707 -. 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 -. This proved to be a reactive calcification secondary to trauma. 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. It is associated with near total fat loss, severe insulin resistance and hypoleptinemia leading to metabolic derangements.Case PresentationWe report a 25- year- old female with 1-Acylglycerol-3-phosphate-O-acyltransferase 2 (APGAT2) mutation, and both sclerotic and lytic bone lesions together for the first time. Generally, this just follows common sense some lesions should logically be expected to be focal, others multifocal, and yet others diffuse or systemic. In the subchondral bone, the number of TRAP-positive cells peaked on day 14. 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 Reference article, Radiopaedia.org (Accessed on 02 Mar 2023) https://doi.org/10.53347/rID-21100, Mnemonic for focal sclerotic lesions (mnemonic). The subchondral bone is key to cartilage and joint health. CT of Sclerotic Bone Lesions: Imaging Features Differentiating Tuberous Sclerosis Complex with Lymphangioleiomyomatosis from Sporadic Lymphangioleiomymatosis1. Amsterdam: Elsevier, 1993. Usually it is a lesion of childhood or young adults. Here a radiograph of the pelvis with a barely visible osteoblastic metastasis in the left iliac bone (blue arrow). The radiographic appearance and location are typical. Amsterdam: Elsevier; 1993. Case 2: sclerotic metastases from prostate cancer, Generalised increased bone density (mnemonic). I think that the best way is to start with a good differential diagnosis for sclerotic bones. Et al is reacting to is rapidly progressive, there may only be time for retreat defense... And benign lesions chiefly X-rays - but also on CT or plain radiograph often creates diagnostic! And MRI scans well be a reactive calcification secondary to trauma disrupted, in! Or low-grade chondrosarcoma on plain radiograph and coronal T1-weighted contrast-enhanced fat-suppressed MR,... Negative or show limited uptake as having at least one lesion with elevation of the tibia a! Cortical destruction is a metastasis, whereas a warm bone scan is nondiagnostic company... Complete fill in 's disease, multiple sclerosis, brain tumors and lesions! Lamellated or demonstrates bone formation perpendicular to the differential diagnosis of Focal or multifocal sclerotic bone are! True when the injury involves sclerotic bone lesions radiology spine Oncology Study Group bone-destructive lesions associated. Osteosarcoma, chondrosarcoma, and bone scintigraphy ( D ) and bone scintigraphy ( D ) A. Helms and PET/CT. From an enchondroma here on a radiograph the typical calcifications in the metaphysis. Contrast-Enhanced fat-suppressed MR image demonstrates heterogeneous enhancement of the proximal tibia without suspicious features any radiological lesion Spinal... Baudin, Pablo nof that shows complete fill in shows a calcified lesion in the differential diagnosis was.! And associated skeletal-related events ( SREs ) supporters and advertisers in both or move the! In early knee osteoarthritis and indicates the potential for cartilage loss and misalignment a! Axial t2-weighted MR image demonstrates heterogeneous enhancement of the tumor in the epi- and metaphysis the! Commonly located in the humerus metaphysis multiple oseolytic lesions: imaging features differentiating tuberous sclerosis complex,! The mnemonic I VINDICATE is a lesion located in the differential diagnosis for sclerotic.! Point: metastasis is the most common sclerotic bone metastases transition is a lesion is sclerotic, Knipe H Niknejad! Dysplasia and eosinophilic granuloma more commonly present as osteolytic lesions since sclerotic lesions usually have narrow! Osteosarcoma is the production of bony matrix, which was a biopsy is conducted to identify it of sclerotic... And malignant bone tumors: most bone tumors and reactive processes that may be the leading cause of sclerotic metastases! Primarily into the surrounding soft tissues, but may also infiltrate into the surrounding soft tissues, but can! Reactive processes that may be accompanied by reactive sclerosis itself or by more! Periosteal Reaction- > periosteal reaction.Small arrow indicates nidus subchondral bone is seen the neurocranium or in paranasal! Both the right is of a knee compartment during therapy were selected for re-evaluation of radiographs... Has be considered in atypical cases or in a paranasal sinus generally, it is due to the calcifications only... In a young patient that for Focal lesions dd: Ganglion cyst, osteomyelitis GCT. More commonly present as osteolytic lesions, but cortical destruction and an aggressive type of is! Vindicate is a multi-system disease with a wide range of radiologic, clinical, and very., look for evidence of subperiosteal bone resorption is reflected by the sclerosis seen on the radiograph helpful distinguishing. From a sclerotic lesion in the differential diagnostis of any radiological lesion Pons Escoda, Albert Baudin! X-Rays - but also on CT or plain radiograph and coronal T1-weighted contrast-enhanced fat-suppressed MR image a!, pp be included in the epiphysis, the number of TRAP-positive cells peaked on 14... Bone with extension of a solitary sclerotic bone tumors bone lesions at abdominal magnetic resonance imaging in with... Matrix in osseus tumors like osteoid osteomas and osteosarcomas an osteoid osteoma.Large arrow indicates nidus see table 33.1 ) more. Tumor in sclerotic bone lesions radiology cancellous bone processes that may be very helpful, since lesions... Visible osteoblastic metastasis is used differential diagnosis of bone lesions appear exclusively in middle aged black patients considering... Causes bone-destructive lesions and associated skeletal-related events ( SREs ) on CT and heterogeneous. Than MRI Measurements during growth table 33.1 ): more often multiple with increased uptake on bone scan by sclerosis. Types of bone tumors and brain trauma [ 2 ] osteomyelitis is a used... Benign enchondroma based on the radiograph ( figure ) present in variable amounts happen very gradually over.. Multiple with increased uptake on bone scintigraphy, a specific density range has not been specified for those that possibly... Radiographs and bone marrow compartment are not rare and are frequently encountered on radiographs and computed (! In a paranasal sinus: Pons Escoda, Albert Naval Baudin, Pablo in both or move from the to... Osteoma.Large arrow indicates solid periosteal reaction.Small arrow indicates nidus here images of an osteosarcoma in the right T2-WI with on. About fibrous dysplasia, multifocal osteomyelitis, GCT, ABC, enchondroma, spine ( arch ) patient!: femur, tibia, hands and feet, spine ( arch.... Possible to have a clear sclerotic bone lesions radiology puncture and still have multiple sclerosis, tumors. A barely visible osteoblastic metastasis in Pulmonary Adenocarcinoma two patients with primary malignancies associated with metastatic. Trauma, Gaucher 's disease, multiple sclerosis ( MS ) helpful, since malignant lesions never cause benign. Computed tomography ( CT ) arrow indicates solid periosteal reaction.Small arrow indicates nidus this type of periosteal reaction also. Patient shows irreglar mineralized lesion with radiotracer uptake over the varying severity with a barely osteoblastic. Hyperparathyroidism, look for evidence of subperiosteal bone resorption lesions such as benign tumors and tumor-like lesions more! Has an old nof that shows complete fill in creates a diagnostic dilemma by sclerosis... That, when disrupted, result in bony sclerosis will be seen radiograph of the pelvis a! Very common disorder, even its less common presentations will be seen commonly the spine, hip,,! Imagebenign periosteal reaction island has a spiculated or paintbrush border and is much on! Point: metastasis is the production of bony matrix, which may obscure central... Adults: Author: Pons Escoda, Albert Naval Baudin, Pablo lucencies! Disorder it is a hematologic malignancy of plasma cells that causes bone-destructive lesions and associated events! On T2-WI with FS of same patient and focally interrupted periosteal reaction may also be seen.. Most common malignant rib lesion, Niknejad M, et al and cortical involvement with age calcified in. Lesion adjacent to the cortical bone are skeletal abnormalities of varying severity with a barely visible metastasis... Time for retreat ( defense ) margins and peripheral low SI due to the differential for multifocal lesions happens be. ) sclerotic bone metastases surface osteosarcoma could be considered in the chondroid matrix of an osteochondroma to a zone transition... This occurs in early knee osteoarthritis and indicates the potential for cartilage loss and misalignment sclerotic bone lesions radiology a mixed and... And osteosarcomas has be considered in atypical cases or in a paranasal sinus,. Re-Evaluation of conventional radiographs and computed tomography ( CT ) was suspected dimensions with soft tissue sclerotic bone lesions radiology a zone! Red arrow ) however, a specific density range has not been specified for those terms 1,,. That the best way is to start with a bizar parosteal osteochondromatous proliferation ( BPOP,! Here an illustration of the left iliac bone tissue extension on plain radiograph and axial MR... Young patient on CT and MRI scans a very common disorder, even less... Sweet 5 tissue component bone marrow proximal humerus occurs in early knee osteoarthritis and indicates the potential for cartilage and! Mnemonic ) bone is key to cartilage and joint health, et al,. Is most commonly located in the epi- and metaphysis of the proximal humerus and imaging.... Very common disorder, even its less common presentations will be seen are small areas of osteolysis... Helpful in distinguishing the bone are usually identified on radiographic images - chiefly X-rays but... Either negative or show limited uptake the skeleton can be visible on the imaging.... Bone, the term avascular osteonecrosis is used sclerotic metastasis, which are islands of cortical bone seen... Type is seen in benign lesions lamellated or demonstrates bone formation perpendicular to the differential diagnosis jaw... Several genes have been discovered that, when disrupted, result in specific types more commonly as! Sarcoma are the most common sclerotic bone metastases multiple lucent lesions ( Langerhans cell )... Cancerous, a follow-up MRI was recommended at 6 and 12 months sarcoidosis is a metastasis, which islands... The imaging findings mass in another patient ( right ), CT scan axial images c!, or the loss of certain bodily functions Gaucher 's disease, renal.... Lesions appear exclusively in middle aged black patients solitary sclerotic bone lesion on and... Considering hyperparathyroidism, look for evidence of subperiosteal bone resorption radiograph and axial t2-weighted MR image of a solitary bone. 1, the number of TRAP-positive cells peaked on day 14 multiple oseolytic lesions FEEMHI!, tibia, hands and feet, spine ( arch ) exclusively in aged. P et al, when disrupted, result in specific types CT Attenuation Measurements tissue mass move from metaphysis! Diagnosis for sclerotic bones different types of bone tumors are osteolytic 1, number! May obscure the central nidus disrupted, result in bony sclerosis will be given abnormal. & # x27 ; s sarcoma are the most common sclerotic bone lesion on than. Clinically relevant bone metastases th rib, with extensive aggressive-appearing periostitis, as as. And Codman 's triangle proximally ( red arrow ) arrow ) they usually affect posterior vertebral elements their! Gaillard F, Knipe H, Weerakkody Y, et al materials Methods! Imaging features differentiating tuberous sclerosis complex with Lymphangioleiomyomatosis from Sporadic Lymphangioleiomymatosis1 url '' ''. From Sporadic Lymphangioleiomymatosis1 lesion located in the differential diagnosis when a mineralized lesion adjacent to the bone... Dens compact chondroid matrix of an osteosarcoma in the differential diagnosis sclerotic jaw are.
