Differential diagnosis based on the periosteal reaction and the extensive edema: Here a patient with a juxtacortical sclerotic mass of the proximal humerus (left). Rib lesions detected on bone scintigraphy often require further characterization with radiography or CT to improve specificity (Figs. Bone islands demonstrate uniformly low Here, we showed that sBT values are higher in patients presenting 496 with bone loss . The location of a bone lesion within the skeleton can be a clue in the differential diagnosis. Magnetic resonance imaging of subchondral bone marrow lesions in association with osteoarthritis. Causes include trauma, infection, autoimmune diseases, inflammatory diseases, spinal degeneration, congenital malformations, and benign or cancerous tumors. A juxtacortical chondrosarcoma has be considered in the differential diagnosis when a mineralized lesion adjacent to the cortical bone is seen. Classic ground glass appearance of the bone. Large lesions tend to expand into both areas. 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. Distinguishing Untreated Osteoblastic Metastases From Enostoses Using CT Attenuation Measurements. 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. In this article we will discuss a systematic approach to the differential diagnosis of bone tumors and tumor-like lesions. 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, Periosteal or juxtacortical chondrosarcoma, Aneurysmal Bone Cyst: Concept, Controversy, Clinical Presentation, and Imaging, Bone Tumors and Tumorlike Conditions: Analysis with Conventional Radiography. W. B. Saunders company 1995, by Mark J. Kransdorf and Donald E. Sweet 5. Purpose: 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. 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. 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. Coronal T1W image shows lobulated margins and peripheral low SI due to the calcifications. MRI also may detect the nidus, combined with abundant bone marrow and soft tissue edema. What does it mean that a lesion is sclerotic? Lippincott Williams & Wilkins. Impact of Sclerotic. Bone metastases are the most common malignancy of bone of which sclerotic bone metastases are less common than lytic bone metastases. Osteoblastic metastases have a lower fracture risk than lytic or mixed bone metastases 11-13. post-treatment appearance of any lytic bone metastasis. Matching the degradation rate of the materials with neo bone formation remains a challenge for bone-repairing materials. Incidentally discovered, benign lesions also called enostoses, which are islands of cortical bone located in the cancellous bone. Acute osteomyelitis is characterised by osteolysis. Home. This could very well be an enchondroma. Etiology A sclerotic border especially indicates poor biological activity. 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. Here an example of a patient with a stress fracture of the distal fibula. This is consistent with the diagnosis of a reactive process like myositis ossificans. Should be included in the differential diagnosis of young patient with multiple lucent lesions (Langerhans cell histiocytosis). Here images of a patient with breast cancer. Ossifications or calcifications can be present in variable amounts. T2-weighted axial MR image demonstrates high signal intensity of the tumor in the metacarpal bone with extension of a lobulated soft tissue mass. The bone marrow compartment is not involved which is important for the surgical strategy. 1. 3. by Mulder JD et al This is a routine medical imaging report. The radiograph shows typical bone infarcts in diaphysis and metaphysis of femur and tibia.. On MR imaging bone infarcts are characterized by irregulair serpentiginous margins with low signal intensity on both T1 and T2 WI and with intermediate to high fat signal in the center part. Ulano A, Bredella M, Burke P et al. The zone of transition only applies to osteolytic lesions since sclerotic lesions usually have a narrow transition zone. 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. Endosteal scalloping of the cortical bone can be seen in benign lesions like Fybrous dysplasia and low-grade chondrosarcoma. Radiographic or CT features that suggest malignancy: Use MRI with water-sensitive sequence (T2 FS) to determine cartilage cap thickness. Less common: Fibrous dysplasia, Brown tumors of hyperparathyroidism, bone infarcts. Ulano A, Bredella M, Burke P et al. Reference article, Radiopaedia.org (Accessed on 02 Mar 2023) https://doi.org/10.53347/rID-22391. Notice the homogeneous thickening of the cortical bone. Not infrequently encountered as coincidental finding at later age. 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 Disappearane of calcifications in a pre-existing enchondroma should raise the suspicion of malignant transformation. Oncol Rev. {"url":"/signup-modal-props.json?lang=us"}, Gaillard F, Knipe H, Weerakkody Y, et al. FD is often purely lytic, but may have a groundglass appearance as the matrix calcifies. Radiological hallmark: formation of a chondroid (cartilagenous) matrix, which presents as punctuated, stippled or popcorn-like calcifications. 2018;2018:1-5. 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. Rib metastases may be osteolytic, sclerotic, or mixed. Calcifications or mineralization within a bone lesion may be an important clue in the differential diagnosis. 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. They can affect any bone and be either benign (harmless) or malignant (cancerous). Infection is seen in all ages. Central location most common with some expansion and cortical thinning. Sclerosis can also be reactive, e.g. In this case, because of the increased uptake on bone scintigraphy, a follow-up MRI was recommended at 6 and 12 months. Osteosarcoma with interrupted periosteal rection and Codman's triangle proximally (red arrow). Diagnostic brain imaging tests can assess bone fractures, structural problems, blood vessel abnormalities, and changes in brain metabolism. 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. 13. 4. Resonance Imaging Saeed M. Bafaraj . Differentiating a bone infarct from an enchondroma or low-grade chondrosarcoma on plain films can be difficult or even impossible. Bone scintigraphy can be either negative or show limited uptake. Bone cyst is one of the manifestations of CGL with AGPAT2 mutation. Diffuse bony sclerosis (mnemonic). Notice the numerous predominantly osteoblastic metastases. 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 Case 2: sclerotic metastases from prostate cancer, Generalised increased bone density (mnemonic). However, cancers that metastasize to bone are very common. The lesson here is that when we are dealing with a very common disorder, even its less common presentations will be seen commonly. 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. DD: old SBC. 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. The mean and maximum attenuation were measured in Hounsfield units. A sclerotic lesion is an unusual hardening or thickening of your bone. Notice the resemblance to a juxtacortical mass in another patient (right), which was a biopsy proven parosteal osteosarcoma. The evaluation of a solitary bony lesion in the spine may be more challenging and will often require additional diagnostic testing if benign imaging features are not present on MRI. Fibrous dysplasia and eosinophilic granuloma more commonly present as osteolytic lesions, but they can be sclerotic. 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. Bone metastases start with the tropism of cancer cells to the bone through different multi-step tumor-host interactions, as described by the . Click here for more detailed information about fibrous dysplasia. Sclerosing bone dysplasias are skeletal abnormalities of varying severity with a wide range of radiologic, clinical, and genetic features. Multiple lucent lesions ( Langerhans cell histiocytosis ) and cortical thinning osteolytic lesions since lesions... Through different multi-step tumor-host interactions, as described by the biological activity remains... 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