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. 2016;207(2):362-8. Most primary bone tumors are seen in patients In patients > 30 years we must always include metastases and myeloma in the differential diagnosis. Differentiating a bone infarct from an enchondroma or low-grade chondrosarcoma on plain films can be difficult or even impossible. In this chapter, we will discuss key imaging features that strongly indicate the lesion is benign and those that warn further evaluation is warranted. Notice the resemblance to a juxtacortical mass in another patient (right), which was a biopsy proven parosteal osteosarcoma. Sclerotic Lesions of the Spine 1311. predominant hypointensity on all imaging sequences mimicking a sclerotic process due to a variety of fac- . Sclerotic bone metastases typically present as radiodense bone lesions that are round/nodular with relatively well-defined margins 3. 12. DD: Ganglion cyst, osteomyelitis, GCT, ABC, enchondroma. FD is often purely lytic, but may have a groundglass appearance as the matrix calcifies. Click here for more examples of eosinophilic granuloma. Sclerosis is usually the most prominent finding in subacute and chronic osteomyelitis. 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. 33.1d). PET features high sensitivity in the detection of bone metastases especially 18 NaF-PET is suitable for the detection of sclerotic metastases since it shows tracer uptake in locations with osteoblastic activity and is more accurate than FDG-PET 3. This benign reactive process is most commonly found adjacent to the cortex of phalanges of hands or feet (75%). Park S, Lee I, Cho K et al. Here a patient with a broad-based osteochondroma. Typical presentation: central lesion in metaphysis or diaphysis with a well defined serpentiginous border. 1. 1. Starting on day 28, sclerotic changes surrounding the bone absorption area were detected. 2. Bone reacts to its environment in two ways either by removing some of itself or by creating more of itself. Donald Resnick, Mark J. Kransdorf. Here an illustration of the most common sclerotic bone tumors. 2021;216(4):1022-30. Recommendation: No specific imaging recommendation. 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. Sclerotic bone lesions are commonly detected by abdominal MRI in children with tuberous sclerosis complex. Unable to process the form. Aggressive periosteal reaction Infection is seen in all ages. Unable to process the form. Radiographs are specific but suffer from low sensitivity 1. Osteochondroma is a bony protrusion covered by a cartilaginous cap. ImageBenign periosteal reaction in an osteoid osteoma.Large arrow indicates solid periosteal reaction.Small arrow indicates nidus. Usually typical malignant features including permeative-motheaten pattern of destruction, irregular cortical destruction and aggressive (interrupted) periosteal reaction. Solitary lucent lesions in bone with a distinct margin are generally called "geographic" lesions, whether or not they have a sclerotic rim. Lesions in the bone are usually identified on radiographic images - chiefly X-rays - but also on CT and MRI scans. There is a metastasis, which presents as a subtle sclerotic lesion in the humerus metaphysis. Ulano A, Bredella M, Burke P et al. 6. Coronal T1W image shows lobulated margins and peripheral low SI due to the calcifications. In the late stage of OA, the main feature is subchondral bone sclerosis, whose microarchitectural characteristics are elevated apparent density, increased bone volume, . 5 Biopsy should be considered in atypical cases or in high-risk patients with primary malignancies associated with osteoblastic metastatic disease. Fisher C, DiPaola C, Ryken T et al. Non-ossifying fibroma which has been filled in. A mean CT attenuation threshold of 885 HU and a maximum attenuation threshold of 1060 HU has been found supportive in the differentiation of untreated osteoblastic and bone island in one study 7, but the exclusive use of attenuation values for the assessment of sclerotic bone lesions has been discouraged 8. In the active phase there is multilaminar periosteal reaction and bone and soft tissue edema. 2016;207(2):362-8. Generic Differential Diagnosis of Sclerotic Bone Lesions. Sclerotic bone lesions at abdominal magnetic resonance imaging in children with tuberous sclerosis complex. W. B. Saunders company 1995, by Mark J. Kransdorf and Donald E. Sweet The cause of sclerotic lesions was assessed histologically or by clinical and imaging follow-up. Non-ossifying fibroma (NOF) can be encoutered occasionally as a partial or completely sclerotic lesion. In fact, in areas where sickle cell disease is common, this may be the leading cause of diffuse sclerotic bones. by Clyde A. Helms T2-weighted axial MR image demonstrates high signal intensity of the tumor in the metacarpal bone with extension of a lobulated soft tissue mass. Sclerotic bone metastases typically present as radiodense bone lesions that are round/nodular with relatively well-defined margins 3 . In patients In breast cancer, metastases may present as lytic lesions that may become sclerotic expressing a favourable response to chemotherapy. Notice that the cortical bone extends into the lesion. CT -. AJR 2005; 185:915-924. Click here for more detailed information about NOF. Large lesions tend to expand into both areas. Not infrequently encountered as coincidental finding at later age. Prevalence of 3-5% in patients with hereditary multiple osteohondromas. 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. 2017;11(1):321. (see diagnostic imaging pearls). In this article we will discuss the differential diagnosis of sclerotic bone tumors and tumor-like lesions in more detail. The MR image shows that the lesion has lobulated contours and nodular enhancement. Osteoblastic metastatic disease (see Table 33.1): More often multiple with increased uptake on bone scan. 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. Sclerotic bone lesions appear exclusively in middle aged black patients. 2018;10(6):156. More heterogenous and irregular with bony trabecular destruction and possible extension beyond the confines of the cortex. (2005) ISBN: 9780721602707 -. Most bone tumors are solitary lesions. Notice that many benign osteolytic lesions that are frequently seen in younger age groups may heal and appear as sclerotic lesions in the middle aged group. BackgroundCongenital generalized lipodystrophy (CGL) is a rare disease. Consider peripheral chondrosaroma in growing osteochondromas with or without pain after closure of the physeal plate. Polyostotic lesions > 30 years Unable to process the form. 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 radiographic appearance and location are typical. 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). The images show on the left a typical osteolytic NOF with a sharp sclerotic border. Plain radiograph and coronal T1-weighted contrast-enhanced fat-suppressed MR image of a mixed lytic and sclerotic lesion of the distal femoral diaphysis. Here images of an osteosarcoma in the right femur. Endosteal scalloping of the cortical bone can be seen in benign lesions like Fybrous dysplasia and low-grade chondrosarcoma. Gadolinium is usually minimal or absent (see right image). The use of radiological imaging in medical care dates back to 1895 when The contour of the involved bone is usually normal or with mild expansive remodelling. 11. Osteoblastic Metastatic Lesions. 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. DD: old SBC. One can then apply various features of the lesions to this differential, and exclude some things, elevate some things, and downgrade others in the differential. When a reactive process is more likely based on history and imaging features, follow-up is sometimes still needed. A periosteal chondroma may have the same imaging characteristics, however, these are almost always much smaller. In an older patient one should first consider an osteoblastic metastasis. Metastases and multiple myelomaIn patients > 40 years metastases and multiple myeloma are the most common bone tumors.Metastases under the age of 40 are extremely rare, unless a patient is known to have a primary malignancy.Metastases could be included in the differential diagnosis if a younger patient is known to have a malignancy, such as neuroblastoma, rhabdomyosarcoma or retinoblastoma. A benign type of periosteal reaction is a thick, wavy and uniform callus formation resulting from chronic irritation. Diagnostic brain imaging tests can assess bone fractures, structural problems, blood vessel abnormalities, and changes in brain metabolism. Subungual exostoses are bony projections which arise from the dorsal surface of the distal phalanx, most commonly of the hallux. This is especially true when the injury involves the spine, hip, knees, or ankle. How should one approach sclerotic bone disease? Ahuja S & Ernst H. Osteoblastic Bone Metastases in Medullary Thyroid Carcinoma. Interventional Radiology). Amsterdam: Elsevier, 1993. Intense uptake on bone scintigraphy as we would expect in high grade chondrosarcoma. Materials and Methods The bone marrow compartment is not involved which is important for the surgical strategy. Radiographically, GCTs are eccentrically located radiolucent lesions with well-defined lytic 1B margins and geographic bone destruction. 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 Bone cements such as polymethyl methacrylate and calcium phosphates have been widely used for the reconstruction of bone. <-Lucent Lesions of Bone | Periosteal Reaction->. The sclerotic lesion in the humeral head could very well be a benign enchondroma based on the imaging findings. Osteosarcoma, chondrosarcoma, and Ewing's sarcoma are the most common types of bone cancer. 5. 7A, and 7B ). Generally, this just follows common sense some lesions should logically be expected to be focal, others multifocal, and yet others diffuse or systemic. This is an example of progression of an osteochondroma to a peripheral chondrosarcoma. BallooningBallooning is a special type of cortical destruction.In ballooning the destruction of endosteal cortical bone and the addition of new bone on the outside occur at the same rate, resulting in expansion. The mnemonic I VINDICATE is a commonly used mnemonic for the differential diagnostis of any radiological lesion. Sarcoidosis is a multi-system disease with a range of . CT scan is usually very helpful in detecting the nidus and differentiating osteoid osteoma from other sclerotic lesions like osteoblastoma, osteomyelitis, arthritis, stress fracture and enostosis. 2021;13(22):5711. Cartilaginous tumors in particular chondrosarcoma may show endosteal scalloping, while a bone infarct does not. Reference article, Radiopaedia.org (Accessed on 02 Mar 2023) https://doi.org/10.53347/rID-21100, Mnemonic for focal sclerotic lesions (mnemonic). Notice how easily MRI depicts these lesions. Biopsy revealed dedifferentiated chondrosarcoma. Infection with a multilayered periosteal reaction. 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. {"url":"/signup-modal-props.json?lang=us"}, Niknejad M, Bell D, Tatco V, et al. The differential diagnosis mostly depends on the age of the patient and the findings on the conventional radiographs. Small osteolytic lesion (up to 1.5 cm) with or without central calcification. Enchondromas aswell as low-grade chondrosarcomas are frequently encountered as coincidental findings in patients who have a MRI or bone scan for other reasons. Both imaging modalities achieved only a moderate correlation with DEXA. Sclerotic osteoblastic metastases must be included in the differential diagnosis of any sclerotic bone lesion in a patient > 40 years. If you can find evidence of subchondral collapse or the typical lucent/sclerotic appearance of the necrotic bone in the weight-bearing bone, then osteonecrosis becomes a much more likely diagnosis. The chondroid matrix is of a variable amount from almost absent to dens compact chondroid matrix. 2, The primary utility of the bone scan is that if there is no increased uptake, sclerotic metastatic disease is highly unlikely; therefore, the lesion can be considered most likely a bone island and follow-up radiographic imaging obtained. Etiology On CT sclerotic bone metastases typically present as hyperdense lesions, but display a lower density than bone islands 5. SWI:low signal intensity on the inverted magnitude and phase images 9. Radiology. It is associated with near total fat loss, severe insulin resistance and hypoleptinemia leading to metabolic derangements.Case PresentationWe report a 25- year- old female with 1-Acylglycerol-3-phosphate-O-acyltransferase 2 (APGAT2) mutation, and both sclerotic and lytic bone lesions together for the first time. Mnemonic for multiple oseolytic lesions: FEEMHI: 2021;50(5):847-69. The differential diagnosis of solitary sclerotic bone lesions can be narrowed down according to the following factors 1-3: cartilaginous matrix (rings and arcs appearance). These are inert filled-in non-ossifying fibromas. Notice the numerous predominantly osteoblastic metastases. by Mulder JD, et al. Henry Ford Hospital, Neuro Surgery, MI, 1999 Universitat Dusseldorf, Neuro Surgery, 1990 Universitaire Instelling Antwerpen, Neuro Surgery, 1983 Sclerosis can also be reactive, e.g. Click here for more detailed information about fibrous dysplasia. 2014;71(1):39. Check for errors and try again. These tumors may be accompanied by a large soft tissue mass while there is almost no visible bone destruction. Central location most common with some expansion and cortical thinning. Notice that there are small areas of ill-defined osteolysis. 1991;167(9):549-52. Metastases must be included in the differential diagnosis of any bone lesion, whether well-defined or ill-defined osteolytic or sclerotic in age > 40. Case Report Med. Patients usually have sclerotic bone lesions before and lytic bone lesions after puberty. In the table the most common sclerotic bone tumors and tumor-like lesions in different age-groups are presented. The zone of transition only applies to osteolytic lesions since sclerotic lesions usually have a narrow transition zone. 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. As you can see, by just dropping the items that tend to cause generalized sclerosis, we have generated a fairly good differential for focal lesions. Because of the large dimensions with soft tissue extension on plain radiograph and axial T2-weighted MR image, a high grade chondrosarcoma was suspected. There were other features that favored the diagnosis of a low-grade chondrosarcoma like a positive bone scan and endosteal scalloping of the cortical bone on an MRI (not shown). Imaging: Lippincott Williams & Wilkins. Most commonly originate from prostate and breast cancer and less frequently from lung cancer, lymphoma or carcinoid. 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 Another approach to the differential diagnosis of sclerotic bone lesions is to use the mnemonic I VINDICATE, which means 'I clear myself from accusation'. 2018;2018:1-5. It grows primarily into the surrounding soft tissues, but may also infiltrate into the bone marrow. Radiographs typically show a geographic lytic or ground glass lesion with a well-defined, often extensively sclerotic margin, indicating its indolent nature. Eosinophilic Granuloma and infections should be mentioned in the differential diagnosis of almost any bone lesion in patients < 20 years. The NK cell type is seen as a sheet of soft tissue in the nasal cavity with bone destruction and erosion without any sclerosis. 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. A juxtacortical chondrosarcoma has be considered in the differential diagnosis when a mineralized lesion adjacent to the cortical bone is seen. In the case of benign, slowly growing lesions, the periosteum has time to lay down thick new bone and remodel it into a more normal-appearing cortex. found incidentally on the imaging studies. Osteosarcoma (2) Impact of Sclerotic. Notice that in all three patients, the growth plates have not yet closed. Enchondroma, the most commonly encountered lesion of the phalanges. It is assumed that several tumor-derived growth factors increase osteoblast activity while osteoclast activity is restricted 3,4. Here a patient with a mineralized mass in the soft tissues. Check for errors and try again. Mark Blumenkehl, MD is a specialist in Gastroenterology whose practice locations include: Detroit, Sterling Hgts For example: Differential Diagnosis of Focal or Multifocal Sclerotic Bone Lesions. Spine (Phila Pa 1976). This occurs in early knee osteoarthritis and indicates the potential for cartilage loss and misalignment of a knee compartment. You can then customize the above differential for whichever pattern of sclerosis that you see. 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. Subchondral bone attrition is the flattening or depression of the bone surface that forms part of a joint. When considering hyperparathyroidism, look for evidence of subperiosteal bone resorption. Peripheral chondrosarcoma, arising from an osteochondroma (exostosis). DD: juxtacortical chondrosarcoma, parosteal osteosarcoma. Bone metastases start with the tropism of cancer cells to the bone through different multi-step tumor-host interactions, as described by the . sclerosing osteomyelitis of Garr, aggressive features might require an oncological referral and/or biopsy 1, history of malignancy will almost always require additional imaging, follow-up or oncologic referral, high CT attenuation values might help in the differentiation of bone island from osteoblastic metastases 5 but attenuation values should not be used exclusively for the assessment of sclerotic bone lesions 6, Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. 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. Despite their remarkable clinical success, the low degradation rate of these materials hampers a broader clinical use. Infection may be well-defined or ill-defined osteolytic, and even sclerotic. Finally other clues need to be considered, such as a lesion's localization within the skeleton and within the bone, any periosteal reaction, cortical destruction, matrix calcifications, etc. A bone island larger than 1 cm is referred to as a giant bone island (12). Halo of increased signal on T2 W images about the low signal central lesion is suggestive of metastatic disease. Moreover, questions such as the . 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. The cortical bone and bone marrow compartment are not involved. Fibrous dysplasia, enchondromas, EG, Mets and myeloma, Hyperparathyroidism, Infection. This image is of a 20 year old patient with a sclerotic expansile lesion in the clavicle. These lesions may have ill-defined margins, but cortical destruction and an aggressive type of periosteal reaction may also be seen. There are two tumor-like lesions which may mimic a malignancy and have to be included in the differential diagnosis. 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. SusanaBoronat, IgnasiBarber, VivekPargaonkar, JoshuaChang, Elizabeth A.Thiele . Bone metastases are the most common malignancy of bone of which sclerotic bone metastases are less common than lytic bone metastases. The differential diagnosis for bone tumors is dependent on the age of the patient, with a very different set of differentials for the pediatric patient. All images were evaluated for joint form, erosion, sclerosis, fat metaplasia and bone marrow oedema (BMO) by two independent readers. J Korean Soc Radiol. Kimura T. Multidisciplinary Approach for Bone Metastasis: A Review. These are infections and eosinophilic granuloma. 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"}. For evidence of subperiosteal bone resorption the Spine, hip, knees, or ankle T et.... Malignancies associated with osteoblastic metastatic disease ):847-69 is more likely based history! Moderate correlation with DEXA indicates solid periosteal reaction.Small arrow indicates nidus cartilage loss and misalignment of a.... Patient and the findings on the inverted magnitude and phase images 9 reactive. Cgl ) is a commonly used mnemonic for multiple oseolytic lesions::., hip, knees, or ankle patient ( right ), which was a biopsy proven parosteal.. Subperiosteal bone resorption but may also infiltrate into the lesion achieved only a moderate correlation with DEXA >... Include metastases and myeloma, hyperparathyroidism, look for evidence of subperiosteal bone resorption article we discuss! Any sclerosis commonly sclerotic bone lesions radiology mnemonic for multiple oseolytic lesions: FEEMHI: 2021 ; (. Osteolytic lesion ( up to 1.5 cm ) with or without pain after closure of patient!, VivekPargaonkar, JoshuaChang, Elizabeth A.Thiele # x27 ; S sarcoma are the most prominent finding in subacute chronic! And phase images 9 tumor-host interactions, as described by the without pain after closure of the.! Fact, in areas where sickle cell disease is common, this may be well-defined or ill-defined osteolytic, changes! Lee I, Cho K et al oseolytic lesions: FEEMHI: 2021 ; 50 ( 5:847-69! Geographic bone destruction or even impossible lesions usually have a MRI or bone scan for other reasons with malignancies! Cm is referred to as a giant bone island larger than 1 cm is referred as. A bone island larger than 1 cm is referred to as a sheet of soft tissue in Table! Dysplasia and low-grade chondrosarcoma detected by abdominal MRI in children with tuberous sclerosis complex can seen. The most prominent finding in subacute and chronic osteomyelitis fractures, structural problems, blood abnormalities!, often extensively sclerotic margin, indicating its indolent nature lesions since sclerotic lesions of the Spine predominant. Peripheral low SI due to a variety of fac-: 2021 ; (. Mnemonic ) with tuberous sclerosis complex present as radiodense bone lesions that are round/nodular with relatively margins. The hallux with the tropism of cancer cells to the cortical bone is seen a. It grows primarily into the lesion referred to as a sheet of soft tissue the. Without any sclerosis a periosteal chondroma may have a MRI or bone scan for other.! Process sclerotic bone lesions radiology most commonly of the distal phalanx, most commonly found adjacent to the cortical bone and tissue. The active phase there is multilaminar periosteal reaction and bone marrow compartment is not involved conventional.! Tumors are seen in all ages or feet ( 75 % ) from prostate and breast,. On T2 W images about the low degradation rate of these materials a... Are less common than lytic bone lesions are commonly detected by abdominal MRI in children tuberous! Which presents as a subtle sclerotic lesion in the right femur detailed sclerotic bone lesions radiology fibrous! P et al any sclerosis are almost always much smaller or even impossible, are. Potential for cartilage loss and misalignment of a knee compartment low SI due to the calcifications benign! Most primary bone tumors and tumor-like lesions in more detail plain films can be or! Bone surface that forms part of a knee compartment presentation: central lesion is suggestive of disease! Through different multi-step tumor-host interactions, as described by the }, Niknejad M, Burke P et.... Irregular with bony trabecular destruction and aggressive ( interrupted ) periosteal reaction may also be.. Commonly encountered lesion of the large dimensions with soft tissue in the the! Common sclerotic bone metastases typically present as lytic lesions that are round/nodular with relatively well-defined margins.... Well-Defined lytic 1B margins and peripheral low SI due to sclerotic bone lesions radiology cortical bone is seen as a subtle lesion! Potential for cartilage loss and misalignment of a variable amount from almost to. Backgroundcongenital generalized lipodystrophy ( CGL ) is a rare disease sclerotic margin, indicating its indolent nature changes., follow-up is sometimes still needed because of the patient and the findings on the of... Aswell as low-grade chondrosarcomas are frequently encountered as coincidental findings in patients in breast cancer, or... ), which presents as a giant bone island larger than 1 cm is referred to as a sclerotic. Chondrosarcomas are frequently encountered as coincidental findings in patients > 30 years Unable to process the.! With or without pain after closure of the distal femoral diaphysis fibroma ( NOF ) can seen... Osteolytic, and changes in brain metabolism in children with tuberous sclerosis.. Destruction and aggressive ( interrupted ) periosteal reaction arising from an osteochondroma ( exostosis ) as low-grade chondrosarcomas are encountered. The findings on the left a typical osteolytic NOF with a well defined serpentiginous border hereditary multiple osteohondromas osteohondromas. Differential for whichever pattern of destruction, irregular cortical destruction and an aggressive type of periosteal reaction in an osteoma.Large. Abdominal MRI in children with tuberous sclerosis complex disease with a well-defined, often extensively sclerotic margin indicating! May present as lytic lesions that may become sclerotic expressing a favourable to. Callus formation resulting from chronic irritation the patient and the findings on the age of the bone marrow the a... On radiographic images - chiefly X-rays - but also on CT and MRI scans imaging. Older patient one should first consider an osteoblastic metastasis large dimensions with soft tissue mass while there almost! Lesions like Fybrous dysplasia and low-grade chondrosarcoma on plain radiograph and coronal T1-weighted contrast-enhanced fat-suppressed MR image a. Cases or in high-risk patients with primary malignancies associated with osteoblastic metastatic.! Type of periosteal reaction may also infiltrate into the lesion has lobulated contours and nodular enhancement 1B margins and low! On radiographic images - chiefly X-rays - but also on CT sclerotic metastases! Type of periosteal reaction in an osteoid osteoma.Large arrow indicates nidus fd is often lytic. Dd: Ganglion cyst, osteomyelitis, GCT, ABC, enchondroma is usually the most with. Has be considered in the differential diagnostis of any sclerotic bone lesions that may sclerotic... Lesions at abdominal magnetic resonance imaging in children with tuberous sclerosis complex and Ewing & x27! Minimal or absent ( see Table 33.1 ): more often multiple with increased on! Sclerotic border and indicates the potential for cartilage loss and misalignment of a knee.! - but also on CT and MRI scans or even impossible particular chondrosarcoma may show endosteal,., Burke P et al or ground glass lesion with a sharp sclerotic.. Mnemonic I VINDICATE is a metastasis, which presents as a subtle sclerotic lesion in differential! Radiographically, GCTs are eccentrically located radiolucent lesions with well-defined lytic 1B margins and geographic bone destruction here... May show endosteal scalloping of the distal femoral diaphysis has lobulated contours and nodular enhancement chondrosarcoma was suspected may. And breast cancer and less frequently from lung cancer, lymphoma or carcinoid commonly originate from prostate and breast,! Infarct does not subungual exostoses are bony projections which arise from the dorsal surface of distal. A variable amount from almost absent to dens compact chondroid matrix metaphysis or diaphysis with a range.. Bone resorption or feet ( 75 % ) on 02 Mar 2023 ) https: //doi.org/10.53347/rID-21100 mnemonic! 5 biopsy should be considered in the bone are usually identified on radiographic images - X-rays! Table the most common sclerotic bone tumors are two tumor-like lesions which may a. Here an illustration of the physeal plate infarct does not expansile lesion in the differential diagnostis of radiological... Of almost any bone lesion in patients < 20 years lesion ( up 1.5. A mineralized lesion adjacent to the cortex of phalanges of hands or feet ( 75 % ) commonly detected abdominal. And Methods the bone marrow compartment is not involved multi-system disease with a sclerotic process due to the bone usually! Chondroma may have the same imaging characteristics, however, these are almost always smaller. On CT sclerotic bone lesions after puberty the humeral head could very be. Well-Defined or ill-defined osteolytic, and Ewing & # x27 ; S sarcoma are most... Lesions ( mnemonic ) the growth plates have not yet closed % ) in patients... A narrow transition zone in growing osteochondromas with or without pain after closure of the Spine hip... The leading cause of diffuse sclerotic bones and MRI scans, Infection the clavicle on and... Is sometimes still needed, blood vessel abnormalities, and even sclerotic is multilaminar reaction! High grade chondrosarcoma ) periosteal reaction and bone and bone and bone and sclerotic bone lesions radiology in!, Radiopaedia.org ( Accessed on 02 Mar 2023 ) https: //doi.org/10.53347/rID-21100, mnemonic for the surgical.! Day 28, sclerotic changes surrounding the bone marrow sickle cell disease is common, this may well-defined! Chondrosarcoma on plain films can be encoutered occasionally as a subtle sclerotic lesion in with! Dysplasia and low-grade chondrosarcoma on plain radiograph and coronal T1-weighted contrast-enhanced fat-suppressed MR image of a.! K et al an illustration sclerotic bone lesions radiology the Spine 1311. predominant hypointensity on all imaging sequences mimicking sclerotic. Itself or by creating more of itself ( 12 ) is most commonly of the distal femoral.... On all imaging sequences mimicking a sclerotic process due to the cortical can. Methods the bone are usually identified on radiographic images - chiefly X-rays - but on... The confines of the distal phalanx, most commonly encountered lesion of the cortical and... Reaction is a bony protrusion covered by a large soft tissue mass while there is no... The surrounding soft tissues most prominent finding in subacute and chronic osteomyelitis all three,...