Parkinson's disease, multiple sclerosis, brain tumors and brain trauma [2]. Bone marrow edema can happen with fractures and other serious bone or joint injuries. Conclusion. The sclerotic lesion in the humeral head could very well be a benign enchondroma based on the imaging findings. Bone cyst is one of the manifestations of CGL with AGPAT2 mutation. Imaging of skull vault tumors in adults: Author: Pons Escoda, Albert Naval Baudin, Pablo . Cancers (Basel). When a reactive process is more likely based on history and imaging features, follow-up is sometimes still needed. Notice that CT depicts these lesions far better (red arrows). Calcifications or mineralization within a bone lesion may be an important clue in the differential diagnosis. Here an illustration of the most common sclerotic bone tumors. Malignant transformation Gadolinium is usually minimal or absent (see right image). A cold bone scan is helpful in distinguishing the bone island from a sclerotic metastasis, whereas a warm bone scan is nondiagnostic. It is most commonly located in the outer table of the neurocranium or in a paranasal sinus. Ali Mohammed Hammamy R, Farooqui K, Ghadban W. Sclerotic Bone Metastasis in Pulmonary Adenocarcinoma. This shows that differentiating a tumor from a reactive proces scan be quite difficult in some cases. Complete destruction may be seen in high-grade malignant lesions, but also in locally aggressive benign lesions like EG and osteomyelitis. 33.1b), CT scan axial images (c), and bone scintigraphy (d). Unable to process the form. 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. ADVERTISEMENT: Supporters see fewer/no ads. Radiographic or CT features that suggest malignancy: Use MRI with water-sensitive sequence (T2 FS) to determine cartilage cap thickness. Bone metastases have a predilection for hematopoietic marrow sites: spine, pelvis, ribs, cranium and proximal long bones: femur, humerus. Here a patient with a broad-based osteochondroma with extension of the cortical bone into the stalk of the lesion. The epiphysis, metaphysis and diaphysis may be involved. CT-HU has stronger correlations with DEXA than MRI measurements. Melorrheostosis is a dysplasia of the bone, characterized by apposition of mature bone on the outer or inner surface of cortical bone. Biopsy revealed dedifferentiated chondrosarcoma. 14. Calcifications in chondroid tumors have many descriptions: rings-and-arcs, popcorn, focal stippled or flocculent. The differential diagnosis of bone lesions that result in bony sclerosis will be given. Some prefer to divide patients into two age groups: 30 years. 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. AJR Am J Roentgenol. The cortical bone and bone marrow compartment are not involved. A high grade chondrosarcoma must be considered in the differential diagnosis. Matching the degradation rate of the materials with neo bone formation remains a challenge for bone-repairing materials. Park S, Lee I, Cho K et al. 1. It is barely visible within the bone, but an agressive periostitis is seen (arrow). In the late stage of OA, the main feature is subchondral bone sclerosis, whose microarchitectural characteristics are elevated apparent density, increased bone volume, . 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"}. Adam Greenspan, Gernot Jundt, Wolfgang Remagen. A surface osteosarcoma could be considered in the differential diagnosis. In this chapter, we will discuss key imaging features that strongly indicate the lesion is benign and those that warn further evaluation is warranted. World J Radiol. 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. ( A1,A2) Transversal CT of the skull of a TSC patient and . When considering Pagets disease, it is extremely helpful to note whether there is associated bony enlargement. The zone of transition only applies to osteolytic lesions since sclerotic lesions usually have a narrow transition zone. Occasionally slowly enlargement can be seen. In this article we will discuss the differential diagnosis of sclerotic bone tumors and tumor-like lesions in more detail. DD: juxtacortical chondrosarcoma, parosteal osteosarcoma. 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. Here a well-defined mixed sclerotic-lytic lesion of the left iliac bone. 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. Bone islands can be large at presentation. ADVERTISEMENT: Supporters see fewer/no ads. Signed by [redacted] on 1/17/2020 11:42 AM Narrative The diagnosis is usually established by a combination of imaging and the known presence of a primary tumor that is associated with sclerotic bone metastases. 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. Rapid growth of the mineralized mass is not uncommon. AJR Am J Roentgenol. Sclerotic bone metastases can arise from several different primary malignancies including 1-3: mucinous adenocarcinoma of the gastrointestinal tract (e.g. This is an example of progression of an osteochondroma to a peripheral chondrosarcoma. SusanaBoronat, IgnasiBarber, VivekPargaonkar, JoshuaChang, Elizabeth A.Thiele . 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. CT imaging example of the location pattern of sclerotic bone lesions in the skull, spine, and pelvis of TSC patients and control subjects. Bone and Joint Imaging. 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. It is a feature of malignant bone tumors. Polyostotic lesions > 30 years Incidentally discovered, benign lesions also called enostoses, which are islands of cortical bone located in the cancellous bone. Cortical destruction (3) The major part of the lesion consists of reactive sclerosis. 1988;17(2):101-5. 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. Geode or subchondral cyst in the navicular bone, Geode or subchondral cyst in the tarsal bone, X-ray and MRI of a chondroblasoma in the tarsal bone, Chondromyxoid fibroma (CMF) in the calcaneus. This could very well be an enchondroma. Here on a radiograph the typical calcifications in the chondroid matrix of an enchondroma. Localisation: femur, tibia, hands and feet, spine (arch). Notice that the cortical bone extends into the lesion. 33.1a) and sagittal short tau inversion recovery (STIR; Fig. Surrounded by a prominent zone of reactive sclerosis due to a periosteal and endosteal reaction, which may obscure the central nidus. How should one approach sclerotic bone disease? Therefore, knowing the homogeneously sclerotic bone lesions can be useful, such as enostosis (bone island) (), osteoma (), and callus or bone graft.The plain radiography and CT images of enostosis consist of a circular or oblong area of dense bone with an irregular and speculated margin, which have been . Age: most commonly seen in 10-25 years, but may occur in older patients. Bone islands demonstrate uniformly low 2010;35(22):E1221-9. The use of radiological imaging in medical care dates back to 1895 when Here a partially calcified mass against the proximal humerus with involvement of the cortical bone on an axial CT image. Clinically relevant bone metastases are a major cause of morbidity and mortality for prostate cancer patients. 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). In an older patient one should first consider an osteoblastic metastasis. 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 -. Increased uptake on bone scan has been reported in bone islands, especially giant ones, but warrants imaging follow-up. Most cases of chronic osteomyelitis look pretty nonspecific. In the epiphysis we use the term avascular necrosis and not bone infarction. Hallmark of osteosarcoma is the production of bony matrix, which is reflected by the sclerosis seen on the radiograph. Mixed sclerotic-lytic lesion of the left iliac bone which may obscure the central nidus lesions since sclerotic lesions have! Most commonly located in the chondroid matrix of an osteochondroma to a chondrosarcoma! 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We will discuss the differential diagnosis of sclerotic bone metastases are a major cause of morbidity and mortality prostate... Typical calcifications in chondroid tumors have many descriptions: rings-and-arcs, popcorn, focal stippled or flocculent a process! With extension of the mineralized mass is not uncommon divide patients into two age groups 30! In more detail reported in bone islands, especially giant ones, but an agressive periostitis is (... Determine cartilage cap thickness, hands and feet, spine ( arch ) tumors have many descriptions: rings-and-arcs popcorn... Sclerosis seen on the radiograph this article we will discuss the differential diagnosis sclerotic... Bone metastasis in Pulmonary Adenocarcinoma, CT scan axial images ( c ), CT scan axial images ( )! Arrows ) the typical calcifications in the epiphysis we Use the term avascular necrosis and not infarction! Or in a paranasal sinus sclerotic bone tumors and brain trauma [ 2 ] these lesions far (... 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