This could be an osteoblastic metastasis or an osteolytic metastasis that responded to chemotherapy. Henry Ford Hospital, Neuro Surgery, MI, 1999 Universitat Dusseldorf, Neuro Surgery, 1990 Universitaire Instelling Antwerpen, Neuro Surgery, 1983 Small osteolytic lesion (up to 1.5 cm) with or without central calcification. Metastases are the most common malignant bone tumors. Here a lesion in the epiphysis, which was the result of post-traumatic osteonecrosis. Chang C, Garner H, Ahlawat S et al. (see diagnostic imaging pearls). Prevalence of 3-5% in patients with hereditary multiple osteohondromas. Differentiating between a diaphyseal and a metaphyseal location is not always possible. However, a specific density range has not been specified for those terms 1. 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. These are infections and eosinophilic granuloma. Typical presentation: central lesion in metaphysis or diaphysis with a well defined serpentiginous border. The contour of the involved bone is usually normal or with mild expansive remodelling. Journal of Bone Oncology. The image on the right is of a different patient who has an old NOF that shows complete fill in. Differentiating a bone infarct from an enchondroma or low-grade chondrosarcoma on plain films can be difficult or even impossible. Most cases of chronic osteomyelitis look pretty nonspecific. Both of these entities may have an aggressive growth pattern. There are two kinds of mineralization: Chondroid matrix Here an incidental finding of several eccentric sclerotic lesions of the distal femur. 2 ed. 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. Mnemonic for multiple oseolytic lesions: FEEMHI: (2007) ISBN: 9780781779302 -. Solitary lucent lesions in bone with a distinct margin are generally called "geographic" lesions, whether or not they have a sclerotic rim. 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. A brain MRI can . Several genes have been discovered that, when disrupted, result in specific types . A high grade chondrosarcoma must be considered in the differential diagnosis. AJR Am J Roentgenol. Home. 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. Sclerotic jaw lesions are not rare and are frequently encountered on radiographs and computed tomography (CT). Fibrous dysplasia can be monostotic or polyostotic. This is especially true when the injury involves the spine, hip, knees, or ankle. Materials and Methods AJR 1995;164:573-580, Online teaching by the Musculoskeletal Radiology academic section of the University of Washington, by Theodore Miller March 2008 Radiology, 246, 662-674, by Nancy M. Major, Clyde A. Helms and William J. Richardson. Consider peripheral chondrosaroma in growing osteochondromas with or without pain after closure of the physeal plate. For example: Differential Diagnosis of Focal or Multifocal Sclerotic Bone Lesions. ADVERTISEMENT: Supporters see fewer/no ads. Infection is seen in all ages. A popular mnemonic to help remember causes of focal sclerotic bony lesions is: Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. SusanaBoronat, IgnasiBarber, VivekPargaonkar, JoshuaChang, Elizabeth A.Thiele . The homogeneous pattern is relatively uncommon compared to the heterogeneous pattern. The contour of the subchondral bone plate was maintained until day 3, but it was absorbed just under the cartilage defect from day 7 to 14. 2022;51(9):1743-64. A T1w/T2-weighted (T2w) hypointense nonexpansile lesion is seen involving the sacrum (asterisk). Check for errors and try again. Differentiation of Predominantly Osteoblastic and Osteolytic Spine Metastases by Using Susceptibility-Weighted MRI. Large lesions tend to expand into both areas. 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. Fundamentals of Skeletal Radiology, second edition Society of Skeletal Radiology- White Paper. Notice the numerous predominantly osteoblastic metastases. In some cases however the osteolytic nidus can be visible on the radiograph (figure). 7. 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. Symptoms are usually absent, however, in adult patients with a chondroid lesion in a long bone, particularly of larger size, always consider low-grade chondrosarcoma. Mixed lytic/sclerotic lesion of right posterolateral 10 th rib, with extensive aggressive-appearing periostitis, as well as a multilobulated soft tissue component. 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. 2010;35(22):E1221-9. Imaging is often helpful in determining a diagnosis, and it can sometimes make a particular diagnosis nearly certain. There are two patterns of periosteal reaction: a benign and an aggressive type. Cartilaginous tumors in particular chondrosarcoma may show endosteal scalloping, while a bone infarct does not. Here some typical examples of bone tumors in the foot: Fundamentals of Skeletal Radiology, second edition Osteosarcoma with interrupted periosteal rection and Codman's triangle proximally (red arrow). Osteoblastic metastatic disease (see Table 33.1): More often multiple with increased uptake on bone scan. The most common focal metastatic lesions originate from the breast (37%), lung (15%), kidney (6%), and thyroid (4%) 43. Wide zone of transition Giant cell bone tumors are usually benign (not cancerous) but the malignant form can affect the legs, especially near the knees. Fibro-osseous lesion like fibrous dysplasia. The pathogenesis of myeloma-related bone disease (MBD) is the imbalance of the bone-remodeling process, which results from osteoclast activation, osteoblast suppression, and the immunosuppressed bone marrow microenvironment. Axial T1-weighted MR image shows homogeneous low signal intensity due to the compact bone apposition. 9. Paget disease is a chronic disorder of unknown origin with increased breakdown of bone and formation of disorganized new bone. Sclerotic bone lesions at abdominal magnetic resonance imaging in children with tuberous sclerosis complex. Notice that in all three patients, the growth plates have not yet closed. 2. Complete destruction may be seen in high-grade malignant lesions, but also in locally aggressive benign lesions like EG and osteomyelitis. CT Check for errors and try again. Publicationdate 2010-04-10 / update 2022-03-17. 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. 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. However, cancers that metastasize to bone are very common. Osteoblastic metastases (2) 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. MRI features high sensitivity and high specificity for the demonstration of bone metastases in general and for assessing the bone marrow 2,3. Clinically relevant bone metastases are a major cause of morbidity and mortality for prostate cancer patients. A periosteal reaction is a non-specific reaction and will occur whenever the periosteum is irritated by a malignant tumor, benign tumor, infection or trauma. NOF, fibrous dysplasia, multifocal osteomyelitis, enchondromas, osteochondoma, leukemia and metastatic Ewing' s sarcoma. 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. Sclerotic bone metastases typically present as radiodense bone lesions that are round/nodular with relatively well-defined margins 3 . In patients > 30 years, and particularly > 40 years, despite benign radiographic features, a metastasis or plasmacytoma also have to be considered Stress fractures occur in normal (fatigue fractures) or metabolically weakened (insufficiency fractures) bones. Benign periosteal reaction Increased uptake on bone scan has been reported in bone islands, especially giant ones, but warrants imaging follow-up. Osteoblastic metastases have a lower fracture risk than lytic or mixed bone metastases 11-13. post-treatment appearance of any lytic bone metastasis. MRI of the sacrum: axial T1-weighted (T1w; Fig. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. 6. 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). T2-weighted axial MR image demonstrates high signal intensity of the tumor in the metacarpal bone with extension of a lobulated soft tissue mass. Infection with a multilayered periosteal reaction. Ulano A, Bredella M, Burke P et al. Plain radiograph and coronal T1-weighted contrast-enhanced fat-suppressed MR image of a mixed lytic and sclerotic lesion of the distal femoral diaphysis. AJR 1995;164:573-580, Online teaching by the Musculoskeletal Radiology academic section of the University of Washington, by Theodore Miller March 2008 Radiology, 246, 662-674, by Laura M. Fayad, Satomi Kawamoto, Ihab R. Kamel, David A. Bluemke, John Eng, Frank J. Frassica and Elliot K. Fishman. Another approach to the differential diagnosis of sclerotic bone lesions is to use the mnemonic I VINDICATE, which means 'I clear myself from accusation'. DD: juxtacortical chondrosarcoma, parosteal osteosarcoma. This type of periostitis is multilayered, lamellated or demonstrates bone formation perpendicular to the cortical bone. The sclerotic lesion in the humeral head could very well be a benign enchondroma based on the imaging findings. Enchondromas aswell as low-grade chondrosarcomas are frequently encountered as coincidental findings in patients who have a MRI or bone scan for other reasons. It can also be proven histologically. Semin. Small zone of transitionA small zone of transition results in a sharp, well-defined border and is a sign of slow growth.A sclerotic border especially indicates poor biological activity. Here an example of a patient with a stress fracture of the distal fibula. As part of the test, a healthcare professional takes a sample of the CSF Coronal MR image demonstrates subtle low intensity line representing the fracture. A periosteal chondroma may have the same imaging characteristics, however, these are almost always much smaller. . Small area of lucency with adjacent sclerosis at the distal right medial femoral metaphysis that could relate to enthesopathic change or remodeling of a fibroxanthoma of bone.. D'Oronzo S, Coleman R, Brown J, Silvestris F. Metastatic Bone Disease: Pathogenesis and Therapeutic Options. The illustration on the left shows the preferred locations of the most common bone tumors. 2016;207(2):362-8. Case 2: sclerotic metastases from prostate cancer, Generalised increased bone density (mnemonic). Recommendation: No specific imaging recommendation. Here images of a patient with breast cancer. 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