2021;13(22):5711. Sometimes a more solid periosteal reaction is present combined with cortical thickening and broadening of the bone. NOF, fibrous dysplasia, multifocal osteomyelitis, enchondromas, osteochondoma, leukemia and metastatic Ewing' s sarcoma. Rib metastases may be osteolytic, sclerotic, or mixed. If there are multiple or polyostotic lesions, the differential diagnosis must be adjusted. Notice the homogeneous thickening of the cortical bone. Here a lesion in the epiphysis, which was the result of post-traumatic osteonecrosis. 6. About Us; Staff; Camps; Scuba. An ill-defined border with a broad zone of transition is a sign of aggressive growth (1). Giant cell bone tumors are usually benign (not cancerous) but the malignant form can affect the legs, especially near the knees. Radiographs typically show a geographic lytic or ground glass lesion with a well-defined, often extensively sclerotic margin, indicating its indolent nature. This benign reactive process is most commonly found adjacent to the cortex of phalanges of hands or feet (75%). RT @JMGardnerMD: 20 yo M w/ 5 cm lytic bone lesion in proximal tibia metaphysis, sharply demarcated w/ sclerotic rim. Osteoblastic metastases have a lower fracture risk than lytic or mixed bone metastases 11-13. post-treatment appearance of any lytic bone metastasis. 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. The lesion is predominantly calcified. Localisation: femur, tibia, hands and feet, spine (arch). 2016;207(2):362-8. by Mulder JD, et al. Typical presentation: central lesion in metaphysis or diaphysis with a well defined serpentiginous border. Notice that CT depicts these lesions far better (red arrows). Density measurements on CT scan revealed greater than 1,000 HU throughout the lesion. Skeletal Radiol. 2 ed. In breast cancer, metastases may present as lytic lesions that may become sclerotic expressing a favourable response to chemotherapy. Other benign lesions, like solitary bone cyst, fibrous dysplasia, chondroblastoma and other benign bone tumors may become inert and may also become sclerotic. There is reactive sclerosis with a nidus that is barely visible on the radiograph (blue arrow), but clearly visible on the CT (red arrows). Lippincott Williams & Wilkins. Polyostotic lesions This could very well be an enchondroma. The sclerotic lesion in the humeral head could very well be a benign enchondroma based on the imaging findings. Reference article, Radiopaedia.org (Accessed on 02 Mar 2023) https://doi.org/10.53347/rID-22391. Here an image of a patient with chronic osteomyelitis. A Codman's triangle refers to an elevation of the periosteum away from the cortex, forming an angle where the elevated periosteum and bone come together. 1988;17(2):101-5. The differential diagnosis of bone lesions that result in bony sclerosis will be given. Parkinson's disease, multiple sclerosis, brain tumors and brain trauma [2]. Diffuse skeletal infarcts can be a common cause of diffuse skeletal sclerosis. These are inert filled-in non-ossifying fibromas. 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. 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. This 'neocortex' can be smooth and uninterrupted, but may also be focally interrupted in more aggressive lesions like GCT. D'Oronzo S, Coleman R, Brown J, Silvestris F. Metastatic Bone Disease: Pathogenesis and Therapeutic Options. Enhancement after i.v. 33.1d). Distinguishing Untreated Osteoblastic Metastases From Enostoses Using CT Attenuation Measurements. brae in keeping with diffuse bone infarcts. Finally, we conclude with a case of an incidentally presenting sclerotic vertebral body lesion. Centrally there is an ill-defined osteolytic area. Osteosarcoma, chondrosarcoma, and Ewing's sarcoma are the most common types of bone cancer. It is nost commonly located on the posterior side of the distal meta-diaphysis of the femur. The illustration on the left shows the preferred locations of the most common bone tumors. Non-ossifying fibroma which has been filled in. Here a rather wel-defined eccentric lesion which is predominantly sclerotic. Benign periosteal reaction Endosteal scalloping of the cortical bone can be seen in benign lesions like Fybrous dysplasia and low-grade chondrosarcoma. Click here for more information about bone island. 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. Bone metastases have a predilection for hematopoietic marrow sites: spine, pelvis, ribs, cranium and proximal long bones: femur, humerus. WSI digital slide: https://kikoxp.com/posts/4606. Guidelines for the Diagnostic Management of Incidental Solitary Bone Lesions on CT and MRI in Adults: Bone Reporting and Data System (Bone-RADS). It classically presents with nocturnal pain in young patients, painful scoliosis, and marked relief from NSAIDs (nonsteroidal anti-inflammatory drugs). Here a radiograph of the pelvis with a barely visible osteoblastic metastasis in the left iliac bone (blue arrow). Our patient had lytic bone lesions in (femur) long bones and also sclerotic lesions in the pelvic which was . Osteoid matrix in osseus tumors like osteoid osteomas and osteosarcomas. Less dense on CT and more heterogeneous than bone islands. Here Melorrheostosis of the ulna with the appearance of candle wax. ( A1,A2) Transversal CT of the skull of a TSC patient and . Mirels H. Metastatic Disease in Long Bones: A Proposed Scoring System for Diagnosing Impending Pathologic Fractures. 10. Case 7: metastases from prostate carcinoma, Sclerotic bone pseudolesions - external artifact, bizarre parosteal osteochondromatous proliferation (Nora lesion), conventional intramedullary chondrosarcoma, dysplasia epiphysealis hemimelica (Trevor disease), solitary bone plasmacytoma with minimal bone marrow involvement, mixed lytic and sclerotic bone metastases, Lodwick classification of lytic bone lesions, Modified Lodwick-Madewell classification of lytic bone lesions. Chrondroid tumors are more frequently encountered than bone infarcts. 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. Causes: corticosteroid use, sickle cell disease, trauma, Gaucher's disease, renal transplantation. The NK cell type is seen as a sheet of soft tissue in the nasal cavity with bone destruction and erosion without any sclerosis. 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. I think that the best way is to start with a good differential diagnosis for sclerotic bones. In Section 2, we give the general technical route for classification, detection and segmentation of multiple-lesion.After that, in Section 3, the paper will review the recognition of multiple-lesion in six organ and tissue areas, including brain, eye, skin, breast, lung, and abdomen. The images show on the left a typical osteolytic NOF with a sharp sclerotic border. by Mulder JD et al Patients usually have sclerotic bone lesions before and lytic bone lesions after puberty. CT Brant WE, Helms CA. This is opposed to myositis ossificans which may present very close to the cortical bone, but maturation develops from the center to the periphery. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. Sclerotic or osteoblastic bone metastases are distant tumor deposits of a primary tumor within bone characterized by new bone deposition or new bone formation. In this article we will discuss a systematic approach to the differential diagnosis of bone tumors and tumor-like lesions. Benign lesion consisting of well-differentiated mature bone tissue within the medullary cavity. The bone marrow compartment is not involved which is important for the surgical strategy. 7A, and 7B ). Sclerotic bone lesions appear exclusively in middle aged black patients. Small osteolytic lesion (up to 1.5 cm) with or without central calcification. If the disorder it is reacting to is rapidly progressive, there may only be time for retreat (defense). 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"}. There is no calcification and lesions may be expansile. 2021;50(5):847-69. There are a number of other helpful findings you can look for that can help you to cone in on or away from specific entities in one of these differential lists. Most commonly encountered bone tumor in the small bones of the hand and foot. 4. Interventional Radiology). 2019;15:100205. The sclerotic lesion in the humeral head could very well be a benign enchondroma based on the imaging findings. On CT sclerotic bone metastases typically present as hyperdense lesions, but display a lower density than bone islands 5. Lesions in the bone are usually identified on radiographic images - chiefly X-rays - but also on CT and MRI scans. Skeletal Radiol. Growth has been demonstrated well after skeletal maturity. This shows that differentiating a tumor from a reactive proces scan be quite difficult in some cases. The image on the right is of a different patient who has an old NOF that shows complete fill in. Bone metastases are the most common malignancy of bone of which sclerotic bone metastases are less common than lytic bone metastases. Matching the degradation rate of the materials with neo bone formation remains a challenge for bone-repairing materials. 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. There are two patterns of periosteal reaction: a benign and an aggressive type. 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. The mean and maximum attenuation were measured in Hounsfield units. Concerning the above factors the differential diagnosis includes the following lesions 1-3: sclerotic bone metastasis: might be solitary because no others are present or have been imaged, infection: e.g. Fibro-osseous lesion like fibrous dysplasia. After an injury, different types of fluid can build up in a bone. Differential Diagnosis in Orthopaedic Oncology. However, the exact mechanism that leads to osteoblastic formation is not entirely elucidated. Differential diagnosis based on the periosteal reaction and the extensive edema: Here a patient with a juxtacortical sclerotic mass of the proximal humerus (left). Subchondral bone attrition is the flattening or depression of the bone surface that forms part of a joint. Click here for more examples of eosinophilic granuloma. 2015;7(8):202-11. They usually affect posterior vertebral elements and their number and size increase with age. Generally, this just follows common sense some lesions should logically be expected to be focal, others multifocal, and yet others diffuse or systemic. Mild mass effect on adjacent lung, diaphragm, and liver. An aggressive type is seen in malignant tumors, but also in benign lesions with aggressive behavior, such as infections and eosinophilic granuloma. Ali Mohammed Hammamy R, Farooqui K, Ghadban W. Sclerotic Bone Metastasis in Pulmonary Adenocarcinoma. The use of PET/CT imaging with new radiotracers enables a non-invasive assessment of the presence of the target of treatment in the whole body and provides the possibility to combine functional information with anatomical details. Is important for the surgical strategy by Mulder JD et al bone disease: Pathogenesis and Therapeutic Options measured Hounsfield. 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For retreat ( defense ) that differentiating a tumor from a reactive proces scan be quite difficult in some.! Bone of which sclerotic bone lesions before and lytic bone lesions appear exclusively in aged! Metastases may present as lytic lesions that result in bony sclerosis will be given image on the left the! Can affect the legs, especially near the knees System for Diagnosing Impending Pathologic Fractures disease!
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