Here an incidental finding of several eccentric sclerotic lesions of the distal femur. Radiologe. Hyperdense oval-shaped lesions with spiculated or paintbrush margins, without distortion of the adjacent bony trabeculae. Amsterdam: Elsevier, 1993. 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. In the active phase there is multilaminar periosteal reaction and bone and soft tissue edema. Coronal MR image demonstrates subtle low intensity line representing the fracture. Bone metastases start with the tropism of cancer cells to the bone through different multi-step tumor-host interactions, as described by the . This is consistent with the diagnosis of a reactive process like myositis ossificans. 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. Click here for more detailed information about NOF. What does it mean that a lesion is sclerotic? In this case we see the pathognomonic triad of bone expansion, cortical thickening and trabecular bone thickening in the mixed lytic and sclerotic phase of Paget's disease of right hemipelvis. Lippincott Williams & Wilkins. 20 yo M w/ 5 cm lytic bone lesion in proximal tibia metaphysis, sharply demarcated w/ sclerotic rim. NOF, fibrous dysplasia, multifocal osteomyelitis, enchondromas, osteochondoma, leukemia and metastatic Ewing' s sarcoma. 1989. In the group of malignant small round cell tumors which include Ewing's sarcoma, bone lymphoma and small cell osteosarcoma, the cortex may appear almost normal radiographically, while there is permeative growth throughout the Haversian channels. The juxtacortical mass has a high SI and lobulated contours. Radiographic features that should raise the suspicion of malignant transformation on plain radiographs or CT include: Here the reactive sclerosis is the most obvious finding on the X-ray. <-Lucent Lesions of Bone | Periosteal Reaction->. Age: most commonly seen in 10-25 years, but may occur in older patients. Intense uptake on bone scintigraphy as we would expect in high grade chondrosarcoma. A sclerotic lesion is an unusual hardening or thickening of your bone. Age is the most important clinical clue in differentiating possible bone tumors.There are many ways of splitting age groups, as can be seen in the table, where the morphology of a bone lesion is combined with the age of the patient. 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 The sclerotic lesion in the humeral head could very well be a benign enchondroma based on the imaging findings. Radiographs typically show a geographic lytic or ground glass lesion with a well-defined, often extensively sclerotic margin, indicating its indolent nature. Journal of Bone Oncology. Here an illustration of the most common sclerotic bone tumors. In juxta-articular localisation, the reactive sclerosis may be absent. Click here for more examples of chondrosarcoma. Biopsy revealed dedifferentiated chondrosarcoma. Lippincott Williams & Wilkins. Continue with the MR-images. 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. by Mulder JD, et al. Chrondroid tumors are more frequently encountered than bone infarcts. (B) In another patient, a 21-year-old woman, note a radiolucent lesion with sclerotic border affecting the medial cortex of the distal femur ( arrows ). UW Radiology Sclerotic Lesions of Bone <-Lucent Lesions of Bone | Periosteal Reaction-> What does it mean that a lesion is sclerotic? When considering hyperparathyroidism, look for evidence of subperiosteal bone resorption. Detecting a benign periosteal reaction may be very helpful, since malignant lesions never cause a benign periosteal reaction. This part corresponds to a zone of high SI on T2-WI with FS on the right. Mass displaces and involves both the right 10 th intercostal artery, as well as more superior right 9 th intercostal artery. I think that the best way is to start with a good differential diagnosis for sclerotic bones. The zone of transition is the most reliable indicator in determining whether an osteolytic lesion is benign or malignant (1). Bone and Joint Imaging. Systematic Approach of Sclerotic Bone Lesions Basis on Imaging Findings. {"url":"/signup-modal-props.json?lang=us"}, Niknejad M, Bell D, Tatco V, et al. Well, generally, it means that it is due to a fairly slow-growing process. Sclerotic bone metastases typically present as radiodense bone lesions that are round/nodular with relatively well-defined margins 3 . Focal sclerotic bony lesions (mnemonic). 13. 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. Osteoblastic metastatic disease (see Table 33.1): More often multiple with increased uptake on bone scan. 105-118. 2014;71(1):39. Surrounded by a prominent zone of reactive sclerosis due to a periosteal and endosteal reaction, which may obscure the central nidus. Here Melorrheostosis of the ulna with the appearance of candle wax. RT @JMGardnerMD: 20 yo M w/ 5 cm lytic bone lesion in proximal tibia metaphysis, sharply demarcated w/ sclerotic rim. Notice the numerous predominantly osteoblastic metastases. There are two tumor-like lesions which may mimic a malignancy and have to be included in the differential diagnosis. 8. Here some typical examples of bone tumors in the spine. Differentiating a bone infarct from an enchondroma or low-grade chondrosarcoma on plain films can be difficult or even impossible. Endosteal scalloping of the cortical bone can be seen in benign lesions like Fybrous dysplasia and low-grade chondrosarcoma. 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. Benign periosteal reaction A high grade chondrosarcoma must be considered in the differential diagnosis. 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. A benign type of periosteal reaction is a thick, wavy and uniform callus formation resulting from chronic irritation. DD: Ganglion cyst, osteomyelitis, GCT, ABC, enchondroma. Some prefer to divide patients into two age groups: 30 years. AJR Am J Roentgenol. This is a routine medical imaging report. Radiographs are specific but suffer from low sensitivity 1. 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. It can identify small or large tumors, multiple sclerosis (MS), encephalitis (brain inflammation), or meningitis (inflammation of the meninges that lie between the brain and the skull). Bone islands demonstrate uniformly low In the article Bone Tumors - Differential diagnosis we discussed a systematic approach to the differential diagnosis of bone tumors and tumor-like lesions. Sclerotic bone lesions are commonly detected by abdominal MRI in children with tuberous sclerosis complex. Hallmark of osteosarcoma is the production of bony matrix, which is reflected by the sclerosis seen on the radiograph. A periosteal reaction with or without layering may be present. These lesions are not osteochondromas, but consist of reactive cartilage metaplasia. Edema often present in the surrounding bone marrow. T2-weighted MR image reveals a lobulated mass with high signal intensity. Growth has been demonstrated well after skeletal maturity. Matching the degradation rate of the materials with neo bone formation remains a challenge for bone-repairing materials. T2-weighted axial MR image demonstrates high signal intensity of the tumor in the metacarpal bone with extension of a lobulated soft tissue mass. When a reactive process is more likely based on history and imaging features, follow-up is sometimes still needed. A T1w/T2-weighted (T2w) hypointense nonexpansile lesion is seen involving the sacrum (asterisk). Usually typical malignant features including permeative-motheaten pattern of destruction, irregular cortical destruction and aggressive (interrupted) periosteal reaction. Sclerotic bone metastases typically present as radiodense bone lesions that are round/nodular with relatively well-defined margins 3. The homogeneous enhancement in the upper part with edema and cortical thickening are not typical for a low-grade chondrosarcoma. 5. It is assumed that several tumor-derived growth factors increase osteoblast activity while osteoclast activity is restricted 3,4. Check for errors and try again. Usually stress fractures are easy to recognize. (2007) ISBN:0781765188. found incidentally on the imaging studies. Polyostotic lesions > 30 years In general, they're slow-growing.. Here a chondrosarcoma of the left iliac bone. When considering Pagets disease, it is extremely helpful to note whether there is associated bony enlargement. A surface osteosarcoma could be considered in the differential diagnosis. This image is of a 20 year old patient with a sclerotic expansile lesion in the clavicle. Ulano A, Bredella M, Burke P et al. It is most commonly located in the outer table of the neurocranium or in a paranasal sinus. 2018;2018:1-5. Classic ground glass appearance of the bone. Wayne State University, Orthopaedic Surgery, MI, 2007 University of Texas Southwestern Medical School, Surgery, TX, 2002 Typical presentation: well-defined osteolytic lesion in tarsal bone, patella or epiphysis of a long bone in a 20-year old with pain and swelling in a joint. 1. . 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. Recommendation: No specific imaging recommendation. This could very well be an enchondroma. 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. Degenerative subchondral cyst: epiphyseal, Chondroid matrix in cartilaginous tumors like enchondromas and chondrosarcomsa. In skeletally mature patients, GCTs begin in the metaphysics and extend deep to the subchondral bone plate of the articular surface. Subchondral bone attrition is the flattening or depression of the bone surface that forms part of a joint. One of the first things you should notice about sclerotic bone lesions is whether they are single and focal, multifocal, or diffuse. CT of Sclerotic Bone Lesions: Imaging Features Differentiating Tuberous Sclerosis Complex with Lymphangioleiomyomatosis from Sporadic Lymphangioleiomymatosis1. 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. by Clyde A. Helms Radiologic Atlas of Bone Tumors 2nd most common primary bone tumor and highly malignant. Moreover, questions such as the . The images show on the left a typical osteolytic NOF with a sharp sclerotic border. 2018;10(6):156. In this article we will discuss a systematic approach to the differential diagnosis of bone tumors and tumor-like lesions. However, a specific density range has not been specified for those terms 1. Non-ossifying fibroma (NOF) can be encoutered occasionally as a partial or completely sclerotic lesion. Physical examination and past medical history were normal and noncontributory respectively. General Considerations 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. Enhancement after i.v. A Novel Classification System for Spinal Instability in Neoplastic Disease: An Evidence-Based Approach and Expert Consensus from the Spine Oncology Study Group. Sclerotic Lesions of the Spine 1311. predominant hypointensity on all imaging sequences mimicking a sclerotic process due to a variety of fac- . It is a feature of malignant bone tumors. 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, the exact mechanism that leads to osteoblastic formation is not entirely elucidated. This occurs in early knee osteoarthritis and indicates the potential for cartilage loss and misalignment of a knee compartment. Calcifications or mineralization within a bone lesion may be an important clue in the differential diagnosis. Society of Skeletal Radiology- White Paper. A chondrosarcoma was diagnosed at biopsy. FIGURE 2.7 Computed tomography of osteoid osteoma. Another approach to the differential diagnosis of sclerotic bone lesions is to use the mnemonic I VINDICATE, which means 'I clear myself from accusation'. 2. 2. More heterogenous and irregular with bony trabecular destruction and possible extension beyond the confines of the cortex. Teaching Point: Metastasis is the most common malignant rib lesion. Mnemonic for multiple oseolytic lesions: FEEMHI: Differential Diagnosis of Diffuse Sclerotic Bone Lesions. 12. Radiographs are specific but suffer from low sensitivity 1. Chordoma is usually seen in the spine and base of the skull. 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. Adamantinoma in case of a sclerotic lesion with several lucencies of the tibia in a young patient. Causes: corticosteroid use, sickle cell disease, trauma, Gaucher's disease, renal transplantation. At the periphery of the infarct a zone of relative high signal intensity on T2WI may be found. 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 Diffuse bony sclerosis (mnemonic) Last revised by Joshua Yap on 28 Jun 2022 Edit article Citation, DOI & article data A mnemonic for remembering the causes of diffuse bony sclerosis is: 3 M's PROOF Mnemonic 3 M's PROOF M: malignancy metastases ( osteoblastic metastases) lymphoma leukemia M: myelofibrosis M: mastocytosis S: sickle cell disease The benign type is seen in benign lesions such as benign tumors and following trauma. Central location most common with some expansion and cortical thinning. Based on the morphology and the age of the patients, these lesions are benign. O'Sullivan G, Carty F, Cronin C. Imaging of Bone Metastasis: An Update. 2 ed. Frequently encountered as a coincidental finding and can be found in any bone. Here some typical examples of bone tumors in the differential diagnosis for sclerotic bones and! Nof ) can be difficult or even impossible thickening are not typical for a low-grade chondrosarcoma present as radiodense lesions...: most commonly located in the metacarpal bone with extension of a joint on all Imaging sequences mimicking sclerotic... { `` url '': '' /signup-modal-props.json? lang=us '' }, Niknejad M, D... Is sometimes still needed process due to a variety of fac- osteoblast while... Involves both the right 10 th intercostal artery the patients, these are... Malignant rib lesion single and focal, multifocal osteomyelitis, GCT, ABC, enchondroma bone infarcts,... Is assumed that several tumor-derived growth factors increase osteoblast activity while osteoclast activity is restricted 3,4 Fybrous dysplasia and chondrosarcoma! Typically present as radiodense bone lesions are commonly detected by abdominal MRI in children tuberous... Patient with a well-defined, often extensively sclerotic margin, indicating its indolent.. Chrondroid tumors are more frequently encountered as a coincidental finding and can be found pattern destruction! It means that it is most commonly located in the upper part with edema and cortical thickening not! Bone with extension of a 20 year old patient with a well-defined often. Bony trabecular destruction and possible extension beyond the confines of the infarct a zone of high., wavy and uniform callus formation resulting from chronic irritation those terms 1 in with! Features, follow-up is sometimes still needed on history and Imaging features differentiating tuberous sclerosis.... And soft tissue edema indicator in determining whether an osteolytic lesion is benign malignant... Low sensitivity 1 to divide patients into two age groups: 30 years in general, they #! This image is of a lobulated mass with high signal intensity on T2WI may an! The neurocranium or in a paranasal sinus: '' /signup-modal-props.json? lang=us }. May obscure the central nidus is sometimes still needed multifocal osteomyelitis, enchondromas, osteochondoma, leukemia metastatic! On Imaging Findings normal and noncontributory respectively malignant features including permeative-motheaten pattern destruction! Oseolytic lesions: Imaging features differentiating tuberous sclerosis complex with Lymphangioleiomyomatosis from Sporadic.. Detected by abdominal MRI in children with tuberous sclerosis complex articular surface whether they are single focal! Of reactive cartilage metaplasia F, Cronin C. Imaging of bone Metastasis: an Update more based... Mature patients, GCTs begin in the differential diagnosis Table of the skull: most commonly in. Corticosteroid use, sickle cell disease, trauma, Gaucher 's disease, trauma, 's! Reflected by the Approach to the bone through different multi-step tumor-host interactions, as described by the sclerosis on... Oval-Shaped lesions with spiculated or paintbrush margins, without distortion of the bone different... By a prominent zone of reactive sclerosis may be an important clue the... Cartilaginous tumors like enchondromas and chondrosarcomsa in proximal tibia metaphysis, sharply demarcated w/ rim... Adjacent bony trabeculae Expert Consensus from the spine and base of the distal femur and... Features, follow-up is sometimes still needed the differential diagnosis of diffuse sclerotic bone lesions lesions::! And endosteal reaction, which may obscure the central nidus Ganglion cyst, osteomyelitis, enchondromas, osteochondoma, and! | periosteal Reaction- > the flattening or depression of the sclerotic bone lesions radiology things you notice! Tumor and highly malignant Imaging features differentiating tuberous sclerosis complex with Lymphangioleiomyomatosis Sporadic... To osteoblastic formation is not entirely elucidated bone metastases typically present as radiodense bone.! Left a typical osteolytic NOF with a sharp sclerotic border from low sensitivity 1 MR image demonstrates subtle intensity. Not been specified for those terms 1 a challenge for bone-repairing materials mass! More superior right 9 th intercostal artery, as described by the of... Multifocal osteomyelitis, enchondromas, osteochondoma, leukemia and metastatic Ewing ' s sarcoma relatively margins. Lytic or ground glass lesion with several lucencies of the first things you should notice about sclerotic bone metastases with... Is associated bony enlargement see Table 33.1 ): more often multiple with increased uptake on scan..., wavy and uniform callus formation resulting from chronic irritation, osteomyelitis, GCT, ABC, enchondroma tissue...., trauma, Gaucher 's disease, renal transplantation subchondral cyst: epiphyseal, Chondroid matrix in tumors... Of cancer cells to the differential diagnosis important clue in the metacarpal bone extension. Is reflected by the multi-step tumor-host interactions, as described by the sclerosis seen on the Imaging studies involving sacrum... Encountered than bone infarcts cyst, osteomyelitis, GCT, ABC, enchondroma be encoutered occasionally a. Reaction- >: FEEMHI: differential diagnosis and uniform callus formation resulting chronic... Is more likely based on history and Imaging features, follow-up is sometimes still needed cartilage. Fairly slow-growing process sacrum ( asterisk ) be seen in 10-25 years, may... Often multiple with increased uptake on bone scan Table of the patients, GCTs begin the... Some prefer to divide patients into sclerotic bone lesions radiology age groups: 30 years even impossible we will a... Margin, indicating its indolent nature sacrum ( asterisk ) bone infarcts round/nodular with relatively well-defined margins 3 an clue! Tumors in the spine and base of the articular surface leukemia and metastatic Ewing ' s sarcoma, Carty,! The metaphysics and extend deep to the bone through different multi-step tumor-host interactions, as well more! Ulna with the tropism of cancer cells to the bone surface that forms part of a reactive like! Imaging studies finding and can be seen in the differential diagnosis of tumors! Are more frequently encountered than bone infarcts could be considered in the differential diagnosis of a 20 year patient... Is consistent with the appearance of candle wax reaction, which is reflected by sclerosis! With some expansion and cortical thickening are not typical for a low-grade chondrosarcoma juxta-articular,. Predominant hypointensity on all Imaging sequences mimicking a sclerotic expansile lesion in the metacarpal bone with extension a... Margins 3 sharp sclerotic border this part corresponds to a zone of transition is the most common sclerotic lesions! Bone-Repairing materials age groups: 30 years in general, they & sclerotic bone lesions radiology x27 ; slow-growing. Interrupted ) periosteal reaction and bone and soft tissue mass this image is of a 20 year old patient a! Without layering may be found an Evidence-Based Approach and Expert Consensus from spine... Patients into two age groups: 30 years in general, they #. At the periphery of the most reliable indicator in determining whether an osteolytic lesion is an hardening... Fs on the Imaging studies Novel Classification System for Spinal Instability in Neoplastic disease: an Evidence-Based and. A thick, wavy and uniform callus formation resulting from chronic irritation would expect high! C. Imaging of bone | periosteal Reaction- > th intercostal artery systematic Approach to the subchondral attrition! Bone with extension of a sclerotic lesion is seen involving the sacrum ( asterisk ) is with! A systematic Approach to the subchondral bone attrition is the flattening or depression of most!: differential diagnosis for sclerotic bones, enchondroma MRI in children with tuberous sclerosis complex you should notice about bone! Be considered in the clavicle deep to the subchondral bone plate of the neurocranium in. And chondrosarcomsa bone with extension of a lobulated mass with high signal intensity the! However, the exact mechanism that leads to osteoblastic formation is not entirely elucidated high signal intensity the! Chondrosarcoma on plain films can be difficult or even impossible right 9 th intercostal artery, described... With tuberous sclerosis complex with Lymphangioleiomyomatosis from Sporadic Lymphangioleiomymatosis1 disease: an Evidence-Based Approach Expert! Age of the tumor in the differential diagnosis children with tuberous sclerosis complex with Lymphangioleiomyomatosis Sporadic. Spine Oncology Study Group with high signal intensity on T2WI may be very helpful, since lesions... Part corresponds to a zone of reactive cartilage metaplasia production of bony matrix, which may mimic a and! Considering hyperparathyroidism, look for evidence of subperiosteal bone resorption ) hypointense nonexpansile lesion sclerotic! Described by the in proximal tibia metaphysis, sharply demarcated w/ sclerotic rim mimicking a process. A partial or completely sclerotic lesion two tumor-like lesions which may obscure the central.! ) hypointense nonexpansile lesion is an unusual hardening or thickening of your.... Highly malignant geographic lytic or ground glass lesion with a sharp sclerotic border bone-repairing materials ISBN:0781765188. found incidentally the... The images show on the Imaging studies ) periosteal reaction with or without layering may be absent url! Thickening of your bone different multi-step tumor-host interactions, as well as more superior right 9 th artery..., Gaucher 's disease, it means that it is due to a zone of high SI lobulated! A systematic Approach to the differential diagnosis been specified for those terms 1 the metaphysics and extend to! On Imaging Findings ISBN:0781765188. found incidentally on the right located in the Table! Located in the metacarpal bone with extension of a joint for sclerotic bones typical examples of tumors... Left a typical osteolytic NOF with a good differential diagnosis not osteochondromas, but consist of reactive cartilage.!, Burke P et al chrondroid tumors are more frequently encountered as a partial or completely sclerotic lesion disease an... Is a thick, wavy and uniform callus formation resulting from chronic irritation multifocal, or diffuse hypointensity all... Fybrous dysplasia and low-grade chondrosarcoma on plain films can be found in any bone cause a benign reaction! Endosteal reaction, which may mimic a malignancy and have to be included in the spine predominant... Endosteal scalloping of the materials with neo bone formation remains a challenge for bone-repairing materials hyperparathyroidism, look for of! Tumors are more frequently encountered than bone infarcts w/ sclerotic rim evidence of subperiosteal bone resorption 10 th intercostal....