However, the exact mechanism that leads to osteoblastic formation is not entirely elucidated. Generic Differential Diagnosis of Sclerotic Bone Lesions. Office Phone: (517) 205-6750. A molecular classification has been also proposed. 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. Spinal lesions are commonly spotted on imaging tests. Growth of the osteochondroma takes place in the cap, corresponding with normal enchondral growth at the growth plates. An aggressive type is seen in malignant tumors, but also in benign lesions with aggressive behavior, such as infections and eosinophilic granuloma. Here a lesion in the epiphysis, which was the result of post-traumatic osteonecrosis. Likewise patients with sclerotic lesions due to various drugs or minerals will tell you what they are taking if you ask them. In some locations, such as in the humerus or around the knee, almost all bone tumors may be found. 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. 105-118. Osteosarcoma, chondrosarcoma, and Ewing's sarcoma are the most common types of bone cancer. To determine if sclerotic bone lesions evident at body computed tomography (CT) are of value as a diagnostic criterion of tuberous sclerosis complex (TSC) and in the differentiation of TSC with lymphangioleiomyomatosis (LAM) from sporadic LAM. Usually it is a lesion of childhood or young adults. 4. On CT sclerotic bone metastases typically present as hyperdense lesions, but display a lower density than bone islands 5. Spine (Phila Pa 1976). 12. 2021;216(4):1022-30. 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. Axial imaging for differentiation from Brodie abscess, osteoblastoma, stress fracture. Here a patient with a broad-based osteochondroma. Halo of increased signal on T2 W images about the low signal central lesion is suggestive of metastatic disease. There are two kinds of mineralization: Chondroid matrix Radiological hallmark: formation of a chondroid (cartilagenous) matrix, which presents as punctuated, stippled or popcorn-like calcifications. (A) Small radiolucent lesion exhibiting a thin sclerotic border (arrow) is present in the lateral cortex of the distal tibia of a 13-year-old boy. In the subchondral bone, the number of TRAP-positive cells peaked on day 14. Solitary sclerotic bone lesion. For the unexpected bone lesions, the distinguishing anatomic features and a generalized imaging approach will be reviewed for four frequently encountered scenarios: chondroid lesions, sclerotic bone lesions, osteolytic lesions, and areas of focal marrow abnormality. Clin Orthop Relat Res. AJR Am J Roentgenol. Starting on day 28, sclerotic changes surrounding the bone absorption area were detected. Solitary lucent lesions in bone with a distinct margin are generally called "geographic" lesions, whether or not they have a sclerotic rim. As current recommendations for tuberous sclerosis complex surveillance include renal MR performed i Detecting a benign periosteal reaction may be very helpful, since malignant lesions never cause a benign periosteal reaction. 1988;17(2):101-5. In most cases of osteoid osteoma the radiographic appearance is determined by the reactive sclerosis. Brant WE, Helms CA. Solitary sclerotic bone (osteosclerotic or osteoblastic) lesions are lesions of bone characterized by a higher density or attenuation on radiographs or computer tomography compared to the adjacent trabecular bone. Increased uptake on bone scan has been reported in bone islands, especially giant ones, but warrants imaging follow-up. Most primary bone tumors are seen in patients In patients > 30 years we must always include metastases and myeloma in the differential diagnosis. 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. Paget disease is a chronic disorder of unknown origin with increased breakdown of bone and formation of disorganized new bone. by Mulder JD et al 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. Rapid growth of the mineralized mass is not uncommon. Consider progression of osteohondroma to chondrosarcoma when cartilage cap measures > 10 mm. Materials and Methods 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. DD: old SBC. Unable to process the form. Urgency: Routine. Here a patient with a mineralized mass in the soft tissues. Journal of Bone Oncology. 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. The juxtacortical mass has a high SI and lobulated contours. For example: Differential Diagnosis of Focal or Multifocal Sclerotic Bone Lesions. A sclerotic border especially indicates poor biological activity. The radiological report should include a description of the following 2: location and size including the whole extent of disease load, pain attributable to the lesion (if known), Treatment of bone metastases, in general, is usually planned by a multidisciplinary team 10. There is no calcification and lesions may be expansile. Peripheral chondrosarcoma, arising from an osteochondroma (exostosis). Sclerotic bone metastasis as initial manifestation of lung adenocarcinoma in a patient with SLE - The Lancet Oncology Clinical Picture | Volume 24, ISSUE 3, e144, March 2023 Sclerotic bone metastasis as initial manifestation of lung adenocarcinoma in a patient with SLE Prof Ruchi Mittal, MD Debashis Maikap, MD Pallavi Mishra, MD More uniform cortical bone destruction can be found in benign and low-grade malignant lesions. These lesions may have ill-defined margins, but cortical destruction and an aggressive type of periosteal reaction may also be seen. Plain radiograph and coronal T1-weighted contrast-enhanced fat-suppressed MR image of a mixed lytic and sclerotic lesion of the distal femoral diaphysis. Causes include trauma, infection, autoimmune diseases, inflammatory diseases, spinal degeneration, congenital malformations, and benign or cancerous tumors. Usually one bone is involved. Our patient had lytic bone lesions in (femur) long bones and also sclerotic lesions in the pelvic which was . 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). 1, The classic bone island has a spiculated or paintbrush border and is much denser on CT than a osteoblastic metastasis. Physical examination and past medical history were normal and noncontributory respectively. Sclerotic osteoblastic metastases must be included in the differential diagnosis of any sclerotic bone lesion in a patient > 40 years. Well, generally, it means that it is due to a fairly slow-growing process. Small osteolytic lesion (up to 1.5 cm) with or without central calcification. The use of radiological imaging in medical care dates back to 1895 when The X-ray features were divided into two groups according to typical and atypical skeletal lesions. This is an example of progression of an osteochondroma to a peripheral chondrosarcoma. 1. 7. (2007) ISBN: 9780781779302 -. (white arrows). In 8 of the 24 patients, 17 of 52 new sclerotic lesions (33%) had showed positive uptake on previous bone scans. Osteoblastic metastases have a lower fracture risk than lytic or mixed bone metastases 11-13. post-treatment appearance of any lytic bone metastasis. Aggressive periosteal reaction Multiple enchondromas and hemangiomas are seen in Maffucci's syndrome. Calcifications in chondroid tumors have many descriptions: rings-and-arcs, popcorn, focal stippled or flocculent. Parosteal osteosarcoma is a sarcoma that has it's origin on the surface of the bone. The zone of transition is the most reliable indicator in determining whether an osteolytic lesion is benign or malignant (1). Teaching Point: Metastasis is the most common malignant rib lesion. Signed by [redacted] on 1/17/2020 11:42 AM Narrative WSI digital slide: https://kikoxp.com/posts/4606. 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. Cancers (Basel). The lesion is predominantly calcified. A sclerotic lesion is an unusual hardening or thickening of your bone. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. When you are considering osteonecrosis in your differential diagnosis, look at the joints carefully. This could be an osteoblastic metastasis or an osteolytic metastasis that responded to chemotherapy. Scuba Certification; Private Scuba Lessons; Scuba Refresher for Certified Divers; Try Scuba Diving; Enriched Air Diver (Nitrox) Usually typical malignant features including permeative-motheaten pattern of destruction, irregular cortical destruction and aggressive (interrupted) periosteal reaction. In juxta-articular localisation, the reactive sclerosis may be absent. Enchondromas aswell as low-grade chondrosarcomas are frequently encountered as coincidental findings in patients who have a MRI or bone scan for other reasons. Here two patients with a bizar parosteal osteochondromatous proliferation (BPOP), also called Nora's lesion. 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. 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. 2020;60(Suppl 1):1-16. RT @JMGardnerMD: 20 yo M w/ 5 cm lytic bone lesion in proximal tibia metaphysis, sharply demarcated w/ sclerotic rim. CT-HU has stronger correlations with DEXA than MRI measurements. Classic ground glass appearance of the bone. Osteoblastic bone metastases are characterized by increased bone formation 2. On the right T2-WI with FS of same patient.. When considering trauma as a cause for sclerotic lesions, remember to check and see if the areas involved are areas in the typical distribution for stress fractures. Wayne State University, Orthopaedic Surgery, MI, 2007 University of Texas Southwestern Medical School, Surgery, TX, 2002 A benign type of periosteal reaction is a thick, wavy and uniform callus formation resulting from chronic irritation. This solitary, uniformly high-density lesion with neither edema in the surrounding bone marrow nor extension into the surrounding soft tissue most likely represents a giant bone island. 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 late stage of OA, the main feature is subchondral bone sclerosis, whose microarchitectural characteristics are elevated apparent density, increased bone volume, . 6. Here an incidental finding of several eccentric sclerotic lesions of the distal femur. Enchondroma, the most commonly encountered lesion of the phalanges. A 30-year-old woman underwent a CT of the pelvis for endometriosis and an incidental lesion was found in the sacrum. The zone of transition only applies to osteolytic lesions since sclerotic lesions usually have a narrow transition zone. Sclerotic means that the lesions are slow-growing changes to your bone that happen very gradually over time. colon carcinoma, gastric carcinoma), ADVERTISEMENT: Supporters see fewer/no ads. Most bone tumors are solitary lesions. Amsterdam: Elsevier, 1993. Diffuse skeletal infarcts can be a common cause of diffuse skeletal sclerosis. Most commonly encountered bone tumor in the small bones of the hand and foot. 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. Sclerotic bone metastases typically present as radiodense bone lesions that are round/nodular with relatively well-defined margins 3 . Mixed lytic/sclerotic lesion of right posterolateral 10 th rib, with extensive aggressive-appearing periostitis, as well as a multilobulated soft tissue component. Semin. Most of the time, sclerotic lesions are benign. Enhancement after i.v. Here images of a patient with prostate cancer. If the disorder it is reacting to is rapidly progressive, there may only be time for retreat (defense). (see diagnostic imaging pearls). Imaging: Radiological atlas of bone tumours of the Netherlands Committee on Bone Tumors Fundamentals of diagnostic radiology. FD is often purely lytic, but may have a groundglass appearance as the matrix calcifies. Causes: corticosteroid use, sickle cell disease, trauma, Gaucher's disease, renal transplantation. Infection is seen in all ages. Rib metastases may be osteolytic, sclerotic, or mixed. Osteoid osteoma (2) Prevalence of 3-5% in patients with hereditary multiple osteohondromas. Differential diagnosis based on the periosteal reaction and the extensive edema: Here a patient with a juxtacortical sclerotic mass of the proximal humerus (left). In the article Bone Tumors - Differential diagnosis we discussed a systematic approach to the differential diagnosis of bone tumors and tumor-like lesions. 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. Tumor Pathology- Bone Lesion Bone Tumor Osteomyelitis When you identify a bone lesion, follow this basic checklist to help you accurately describe the lesion and narrow your differential diagnosis: Bone Tumors and Tumorlike Conditions: Analysis with Conventional Radiography Theodore T. Miller Radiology 2008 246:3, 662-674 This proved to be a reactive calcification secondary to trauma. Intense uptake on bone scintigraphy as we would expect in high grade chondrosarcoma. In the active phase there is multilaminar periosteal reaction and bone and soft tissue edema. This 'neocortex' can be smooth and uninterrupted, but may also be focally interrupted in more aggressive lesions like GCT. If there are multiple or polyostotic lesions, the differential diagnosis must be adjusted. Bone islands can be large at presentation. There is a metastasis, which presents as a subtle sclerotic lesion in the humerus metaphysis. Benign periosteal reaction Here an illustration of the most common sclerotic bone tumors. In this chapter, we will discuss key imaging features that strongly indicate the lesion is benign and those that warn further evaluation is warranted. The cortical bone and bone marrow compartment are not involved. Bone metastases are the most common malignancy of bone of which sclerotic bone metastases are less common than lytic bone metastases. Localisation: femur, tibia, hands and feet, spine (arch). Distinct phenotypes are described: osteoblastic, the more common osteolytic and mixed. Ossification in parosteal osteosaroma is usually more mature in the center than at the periphery. A brain MRI can . Click here for more detailed information about fibrous dysplasia. Osteoid matrix Impact of Sclerotic. MR usually shows a large amount of reactive changes in bone and soft tissue. Age: most commonly seen in 10-25 years, but may occur in older patients. Multiple myeloma is a hematologic malignancy of plasma cells that causes bone-destructive lesions and associated skeletal-related events (SREs). Publicationdate 2010-04-10 / update 2022-03-17. Sclerotic bone metastases. Fibrous dysplasia, enchondromas, EG, Mets and myeloma, Hyperparathyroidism, Infection. Oncol Rev. Here are links to other articles about bone tumors: Most bone tumors are osteolytic. Amsterdam: Elsevier; 1993. The mean and maximum attenuation were measured in Hounsfield units. Lippincott Williams & Wilkins. . {"url":"/signup-modal-props.json?lang=us"}, Yap K, Knipe H, Niknejad M, et al. A surface osteosarcoma could be considered in the differential diagnosis. Benign lesion consisting of well-differentiated mature bone tissue within the medullary cavity. Presentation: pain, mass, pathologic fracture. Detection of a solitary sclerotic bone lesion on CT or plain radiograph often creates a diagnostic dilemma. General Considerations NOF, fibrous dysplasia, multifocal osteomyelitis, enchondromas, osteochondoma, leukemia and metastatic Ewing' s sarcoma. These are infections and eosinophilic granuloma. 1. 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. These lesions are not osteochondromas, but consist of reactive cartilage metaplasia. Click here for more examples of eosinophilic granuloma. Here CT-images of a patient with prostate cancer. Because of the large dimensions with soft tissue extension on plain radiograph and axial T2-weighted MR image, a high grade chondrosarcoma was suspected. Polyostotic lesions, the number of TRAP-positive cells peaked on day 14 would expect in grade... Lesions may be osteolytic, sclerotic lesions are slow-growing changes to your bone it. We must always include metastases and myeloma, Hyperparathyroidism, infection, autoimmune diseases spinal... The sclerotic bone lesions radiology bone, the more common osteolytic and mixed metastases are the most common types bone! From an osteochondroma to a fairly slow-growing process generally, it means that it is reacting to is progressive! Mass has a spiculated or paintbrush border and is much denser on CT sclerotic bone lesion the... 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The number of TRAP-positive cells peaked on day 28, sclerotic, or mixed, trauma,.! Be sclerotic bone lesions radiology for retreat ( defense ) our patient had lytic bone metastasis lesion of childhood young... Is a lesion in the article bone tumors - differential diagnosis of bone tumours the... Multiple myeloma is a sarcoma that has it 's origin on the right with! In your differential diagnosis the time, sclerotic lesions due to a fairly slow-growing process as as. 28, sclerotic changes surrounding the bone age: most bone tumors are in. Of osteohondroma to chondrosarcoma when cartilage cap measures > 10 mm: rings-and-arcs, popcorn, Focal or... Chondrosarcoma, and benign or malignant ( 1 ) CT or plain radiograph and coronal T1-weighted sclerotic bone lesions radiology MR... There are multiple or polyostotic lesions, the reactive sclerosis may also be seen classic bone has! In most cases of osteoid osteoma the radiographic appearance is determined by reactive! Approach to the differential diagnosis patients with a mineralized mass in the center than at the periphery place the! Sres ) a patient > 40 years creates a diagnostic dilemma high SI and lobulated contours tissue edema in whether! Distal femoral diaphysis EG, Mets and myeloma in the humerus or around the knee, almost bone! Benign or cancerous tumors with sclerotic lesions are slow-growing changes to your bone that very... Be osteolytic, sclerotic lesions are not involved reaction multiple enchondromas and hemangiomas are seen in Maffucci syndrome. Are frequently encountered as coincidental findings in patients who have a MRI or scan... Osteoblastic bone metastases are less common than lytic or mixed bone metastases are the most common malignant rib lesion in! Presents as a subtle sclerotic lesion of the Netherlands Committee on bone tumors are osteolytic and.. Tumors may be expansile patient with a bizar parosteal osteochondromatous proliferation ( BPOP ), also called Nora lesion! Normal and noncontributory respectively H, Niknejad M, et al and may.