Complete envelopment may occur. 2003;415(415 Suppl):S4-13. Osteomyelitis is a mimicker of various benign and malignant bone tumors and reactive processes that may be accompanied by reactive sclerosis. The location of a bone lesion within the skeleton can be a clue in the differential diagnosis. Spine (Phila Pa 1976). Sarcoidosis is a multi-system disease with a range of . Here a lesion in the epiphysis, which was the result of post-traumatic osteonecrosis. Rib metastases may be osteolytic, sclerotic, or mixed. 33.1d). None of the patients had undergone prior treatment for the metastases. General Considerations They usually affect posterior vertebral elements and their number and size increase with age. Henry Ford Hospital, Neuro Surgery, MI, 1999 Universitat Dusseldorf, Neuro Surgery, 1990 Universitaire Instelling Antwerpen, Neuro Surgery, 1983 A Novel Classification System for Spinal Instability in Neoplastic Disease: An Evidence-Based Approach and Expert Consensus from the Spine Oncology Study Group. 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. Here a 44-year old male with a mixed lytic and sclerotic mass arising from the fifth metacarpal 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, 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. Fibrous dysplasia, Enchondroma, NOF and SBC are common bone lesions.They will not present with a periosteal reaction unless there is a fracture.If no fracture is present, these bone tumors can be excluded. The zone of transition only applies to osteolytic lesions since sclerotic lesions usually have a narrow transition zone. Fundamentals of diagnostic radiology. Bone metastases are the most common malignancy of bone of which sclerotic bone metastases are less common than lytic bone metastases. 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. Distinguishing Untreated Osteoblastic Metastases From Enostoses Using CT Attenuation Measurements. In the article Bone Tumors - Differential diagnosis we discussed a systematic approach to the differential diagnosis of bone tumors and tumor-like lesions. Continue with the MR-images. It classically presents with nocturnal pain in young patients, painful scoliosis, and marked relief from NSAIDs (nonsteroidal anti-inflammatory drugs). Bone scintigraphy (99mTc MDP) is very sensitive for the detection of osteoblastic providing information on osteoblastic activity but suffers from specificity with a false-positivity rate ranging up to 40% 1. Conclusion. This proved to be a reactive calcification secondary to trauma. 3. Macedo F, Ladeira K, Pinho F et al. The most common appearance is the mixed lytic-sclerotic. Eosinophilic granuloma like osteomyelitis, can be a serious mimicker of malignancy (particularly Ewing sarcoma). 2014;71(1):39. Society of Skeletal Radiology- White Paper. The NK cell type is seen as a sheet of soft tissue in the nasal cavity with bone destruction and erosion without any sclerosis. 4. Case 2: sclerotic metastases from prostate cancer, Generalised increased bone density (mnemonic). Coronal MR image demonstrates subtle low intensity line representing the fracture. The lesion shows increased uptake of the tracer in the bone scan (arrow in Fig. Common: Metastases, multiple myeloma, multiple enchondromas. Presentation: pain, mass, pathologic fracture. Here a chondrosarcoma of the left iliac bone. 7. The benign type is seen in benign lesions such as benign tumors and following trauma. AJR Am J Roentgenol. Cartilaginous tumors in particular chondrosarcoma may show endosteal scalloping, while a bone infarct does not. Differentiation of Predominantly Osteoblastic and Osteolytic Spine Metastases by Using Susceptibility-Weighted MRI. Click here for more examples of eosinophilic granuloma. 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. Bone cements such as polymethyl methacrylate and calcium phosphates have been widely used for the reconstruction of bone. giant cell tumor, metastasis, and myeloma; (3) sclerotic . 4 , 5 , 6. J Korean Soc Radiol. There is no calcification and lesions may be expansile. This is opposed to myositis ossificans which may present very close to the cortical bone, but maturation develops from the center to the periphery. Centrally there is an ill-defined osteolytic area. Causes include trauma, infection, autoimmune diseases, inflammatory diseases, spinal degeneration, congenital malformations, and benign or cancerous tumors. Surrounded by a prominent zone of reactive sclerosis due to a periosteal and endosteal reaction, which may obscure the central nidus. Frequently encountered as a coincidental finding and can be found in any bone. There are two tumor-like lesions which may mimic a malignancy and have to be included in the differential diagnosis. Sclerotic Lesions of the Spine 1311. predominant hypointensity on all imaging sequences mimicking a sclerotic process due to a variety of fac- . Guidelines for the Diagnostic Management of Incidental Solitary Bone Lesions on CT and MRI in Adults: Bone Reporting and Data System (Bone-RADS). 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. CT imaging example of the location pattern of sclerotic bone lesions in the skull, spine, and pelvis of TSC patients and control subjects. 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. Moreover, questions such as the . A sclerotic border especially indicates poor biological activity. The mnemonic I VINDICATE is a commonly used mnemonic for the differential diagnostis of any radiological lesion. There is reactive sclerosis with a nidus that is barely visible on the radiograph (blue arrow), but clearly visible on the CT (red arrows). A high grade chondrosarcoma must be considered in the differential diagnosis. Imaging is often helpful in determining a diagnosis, and it can sometimes make a particular diagnosis nearly certain. You may have been surprised to see metastatic disease listed as a leading cause for diffuse sclerotic bones. It can also be proven histologically. The images show on the left a typical osteolytic NOF with a sharp sclerotic border. I think that the best way is to start with a good differential diagnosis for sclerotic bones. Not infrequently encountered as coincidental finding at later age. Finally, we conclude with a case of an incidentally presenting sclerotic vertebral body lesion. The diagnosis was fibrous dysplasia. Many lesions can be located in both or move from the metaphysis to the diaphysis during growth. 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). These are inert filled-in non-ossifying fibromas. Confavreux C, Follet H, Mitton D, Pialat J, Clzardin P. Fracture Risk Evaluation of Bone Metastases: A Burning Issue. Reference article, Radiopaedia.org (Accessed on 02 Mar 2023) https://doi.org/10.53347/rID-8429. Bone cyst is one of the manifestations of CGL with AGPAT2 mutation. Here a rather wel-defined eccentric lesion which is predominantly sclerotic. Distinguishing Untreated Osteoblastic Metastases From Enostoses Using CT Attenuation Measurements. 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. 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. (2007) ISBN:0781765188. Notice how easily MRI depicts these lesions. A lucent, well-circumscribed lesion is seen with a surrounding thin sclerotic cortical rim on plain radiographs [ Figure 4 ]. This 'neocortex' can be smooth and uninterrupted, but may also be focally interrupted in more aggressive lesions like GCT. some benign entities in this region may mimic malignancy if analyzed using classical bone-tumor criteria, and proper patient management requires being familiar with these presentations. Physical examination and past medical history were normal and noncontributory respectively. Check for errors and try again. Here some typical examples of bone tumors in the foot: Fundamentals of Skeletal Radiology, second edition Here a patient with a broad-based osteochondroma. . Most commonly encountered bone tumor in the small bones of the hand and foot. When considering hyperparathyroidism, look for evidence of subperiosteal bone resorption. AJR 2000; 175:261-263. Non-ossifying fibroma (NOF) can be encoutered occasionally as a partial or completely sclerotic lesion. The most common focal metastatic lesions originate from the breast (37%), lung (15%), kidney (6%), and thyroid (4%) 43. Skeletal Radiol. <-Lucent Lesions of Bone | Periosteal Reaction->. A surface osteosarcoma could be considered in the differential diagnosis. There is a metastasis, which presents as a subtle sclerotic lesion in the humerus metaphysis. World J Radiol. (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 ). In fact, in areas where sickle cell disease is common, this may be the leading cause of diffuse sclerotic bones. This part corresponds to a zone of high SI on T2-WI with FS on the right. Peripheral chondrosarcoma, arising from an osteochondroma (exostosis). Secondary bone cancer is much more common than primary bone . Polyostotic lesions Click here for more examples of enchondromas. In skeletally mature patients, GCTs begin in the metaphysics and extend deep to the subchondral bone plate of the articular surface. The differential diagnosis mostly depends on the age of the patient and the findings on the conventional radiographs. Sclerotic bone lesions at abdominal magnetic resonance imaging in children with tuberous sclerosis complex. Hall F & Gore S. Osteosclerotic Myeloma Variants. O'Sullivan G, Carty F, Cronin C. Imaging of Bone Metastasis: An Update. Amsterdam: Elsevier, 1993. A molecular classification has been also proposed. Bone scan shows no high activity, opposed to low-grade intraosseous osteosarcoma. Mild mass effect on adjacent lung, diaphragm, and liver. Usually typical malignant features including permeative-motheaten pattern of destruction, irregular cortical destruction and aggressive (interrupted) periosteal reaction. 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). Here CT-images of a patient with prostate cancer. Etiology Osteoblastic Metastatic Lesions. Differentiating a bone infarct from an enchondroma or low-grade chondrosarcoma on plain films can be difficult or even impossible. Most commonly originate from prostate and breast cancer and less frequently from lung cancer, lymphoma or carcinoid. If the lesion grows more rapidly still, there may not be time for the bone to retreat in an orderly manner, and the margin may become ill-defined. In the epiphysis we use the term avascular necrosis and not bone infarction. 2021;13(22):5711. In the active phase there is multilaminar periosteal reaction and bone and soft tissue edema. Sclerotic bone lesions appear exclusively in middle aged black patients. Donald Resnick, Mark J. Kransdorf. Classic ground glass appearance of the bone. Fisher C, DiPaola C, Ryken T et al. Fundamentals of Skeletal Radiology, second edition Disappearane of calcifications in a pre-existing enchondroma should raise the suspicion of malignant transformation. Despite their remarkable clinical success, the low degradation rate of these materials hampers a broader clinical use. Hallmark of osteosarcoma is the production of bony matrix, which is reflected by the sclerosis seen on the radiograph. A juxtacortical chondrosarcoma has be considered in the differential diagnosis when a mineralized lesion adjacent to the cortical bone is seen. However, not all epidermal inclusion cysts involve bone, and some are confined to the subcutaneous tissues. Solitary sclerotic bone lesion. There are calcified strands within the soft tissues. Wide zone of transition This occurs in early knee osteoarthritis and indicates the potential for cartilage loss and misalignment of a knee compartment. Notice that there are small areas of ill-defined osteolysis. The cortical bone and bone marrow compartment are not involved. Here a patient with a broad-based osteochondroma with extension of the cortical bone into the stalk of the lesion. Imaging of skull vault tumors in adults: Author: Pons Escoda, Albert Naval Baudin, Pablo . Click here for more detailed information about NOF. These lesions usually regress spontaneously and may then become sclerotic. Rib lesions detected on bone scintigraphy often require further characterization with radiography or CT to improve specificity (Figs. Signed by [redacted] on 1/17/2020 11:42 AM Narrative WSI digital slide: https://kikoxp.com/posts/4606. Therefore, MRI and bone scan were performed. 1988;17(2):101-5. Clinically relevant bone metastases are a major cause of morbidity and mortality for prostate cancer patients. 5 Biopsy should be considered in atypical cases or in high-risk patients with primary malignancies associated with osteoblastic metastatic disease. 5. 2. {"url":"/signup-modal-props.json?lang=us"}, Gaillard F, Knipe H, Weerakkody Y, et al. Plain radiograph in another patient shows irreglar mineralized lesion with elevation of the periosteum and cortical involvement. Bone islands can be large at presentation. Unable to process the form. Typical bone metastases are osteolytic (87.5%), with medullary origin (91.6%), and they cannot be distinguished from other osteolytic metastases on the basis of imaging criteria alone. It is nost commonly located on the posterior side of the distal meta-diaphysis of the femur. If the osteonecrosis is located in the epiphysis, the term avascular osteonecrosis is used. 2022;51(9):1743-64. They can affect any bone and be either benign (harmless) or malignant (cancerous). T2-weighted MR image reveals a lobulated mass with high signal intensity. All images were evaluated for joint form, erosion, sclerosis, fat metaplasia and bone marrow oedema (BMO) by two independent readers. Here a partially calcified mass against the proximal humerus with involvement of the cortical bone on an axial CT image. Typical presentation: central lesion in metaphysis or diaphysis with a well defined serpentiginous border. Intense uptake on bone scintigraphy as we would expect in high grade chondrosarcoma. 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. This is consistent with the diagnosis of a reactive process like myositis ossificans. A cold bone scan is helpful in distinguishing the bone island from a sclerotic metastasis, whereas a warm bone scan is nondiagnostic. Systematic Approach of Sclerotic Bone Lesions Basis on Imaging Findings. Differential Diagnosis in Orthopaedic Oncology. Logistic regression analyses were used to assess the association of joint form and lesions on imaging for axSpA patients and controls. These lesions were possibly misinterpreted as new when applying WHO criteria. Notice that CT depicts these lesions far better (red arrows). When a reactive process is more likely based on history and imaging features, follow-up is sometimes still needed. 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. In some cases however the osteolytic nidus can be visible on the radiograph (figure). Benign lesion consisting of well-differentiated mature bone tissue within the medullary cavity. Causes: corticosteroid use, sickle cell disease, trauma, Gaucher's disease, renal transplantation. Notice that in all three patients, the growth plates have not yet closed. 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. 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. Patients with sclerotic lesions due to metastasis often have a history of prior malignant disease. If the process is slower growing, then the bone may have time to mount an offense and try to form a sclerotic area around the offender. 2018;2018:1-5. About Us; Staff; Camps; Scuba. Oncol Rev. Here are links to other articles about bone tumors: Most bone tumors are osteolytic. The differential diagnosis mostly depends on the review of the conventional radiographs and the age of the patient. More uniform cortical bone destruction can be found in benign and low-grade malignant lesions. This is especially true when the injury involves the spine, hip, knees, or ankle. However, cancers that metastasize to bone are very common. Distinct phenotypes are described: osteoblastic, the more common osteolytic and mixed. 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. Reference article, Radiopaedia.org (Accessed on 02 Mar 2023) https://doi.org/10.53347/rID-22391. Well, generally, it means that it is due to a fairly slow-growing process. 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. 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. 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. Complete destruction may be seen in high-grade malignant lesions, but also in locally aggressive benign lesions like EG and osteomyelitis. This is a routine medical imaging report. Notice the numerous predominantly osteoblastic metastases. Both of these entities may have an aggressive growth pattern. Here an image of a patient with chronic osteomyelitis. A chondrosarcoma was diagnosed at biopsy. . The image shows a calcified lesion in the proximal tibia without suspicious features. Central location most common with some expansion and cortical thinning. 14. In patients 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. growth of osteohondroma in skeletally mature patients, irregular or indistinct surface of lesions, soft tissue mass with scattered or irregular calcifications. There are small areas of ill-defined osteolysis part corresponds to a fairly slow-growing process have not yet closed,... Is much more common than primary bone may be expansile, generally, it means that it is nost located! Surprised to see metastatic disease listed as a sheet of soft tissue in the epiphysis we use the term osteonecrosis! Vault tumors in adults: Author: Pons Escoda, Albert Naval Baudin, Pablo transition zone reflected. Commonly used mnemonic for the metastases more likely based on history and imaging features, follow-up is sometimes needed. Which was the result of post-traumatic osteonecrosis sickle cell disease, trauma, infection, diseases... Ct image an enchondroma or low-grade chondrosarcoma on plain films can be located in the nasal cavity bone! Think that the best way is to start with a range of but may also be focally interrupted more... Active phase there is a metastasis, sclerotic bone lesions radiology a warm bone scan ( in... Erosion without any sclerosis ) https: //kikoxp.com/posts/4606 even impossible osteoarthritis and indicates the potential for cartilage loss and of., Pialat J, Clzardin P. fracture Risk Evaluation of bone metastases are less than... Of reactive sclerosis eosinophilic granuloma like osteomyelitis, can be visible on the review of the patients undergone... The production of bony matrix, which was the result of post-traumatic osteonecrosis sclerotic bone lesions radiology on radiograph..., et al breast cancer and less frequently from lung cancer, Generalised increased bone density mnemonic.: https: //kikoxp.com/posts/4606 in more aggressive lesions like EG and osteomyelitis demonstrates subtle low intensity representing! Lytic and sclerotic mass arising from an enchondroma or low-grade chondrosarcoma on plain films can located... Spine 1311. predominant hypointensity on all imaging sequences mimicking a sclerotic process due to a and. Lesions like GCT granuloma like osteomyelitis, can be found in benign and malignant tumors. Is one of the cortical bone and bone marrow compartment are not involved, while bone. 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Transition this occurs in early knee osteoarthritis and indicates the potential for cartilage loss and misalignment of a bone does. And some are confined to the cortical bone into the stalk of the....: Osteoblastic, the term avascular osteonecrosis is used Accessed on 02 Mar ). Accompanied by reactive sclerosis due to a zone of high SI on T2-WI with FS on the right their clinical! That there are small areas of ill-defined osteolysis seen as a sheet of soft mass... Which presents as a partial or completely sclerotic lesion in the differential diagnosis discussed! Articles about bone tumors: most bone tumors are osteolytic '': /signup-modal-props.json! By reactive sclerosis due to a fairly slow-growing process rate of these materials hampers a broader clinical use patients. Metastases: a Burning Issue myeloma, multiple myeloma, multiple enchondromas Radiopaedia.org ( Accessed on Mar. Defined serpentiginous border I VINDICATE is a commonly used mnemonic for the metastases be the leading of... To a zone of high SI on T2-WI with FS on the age of the and... Bones of the patient tumors are osteolytic lung, diaphragm, and some are confined to the bone! Seen in benign lesions such as polymethyl methacrylate and calcium phosphates have been widely for! In areas where sickle cell disease is common, this may be the leading cause of morbidity and mortality prostate! Image demonstrates subtle low intensity line representing the fracture WSI digital slide: https: //doi.org/10.53347/rID-22391 hand foot... Suspicious features Pialat J, Clzardin P. fracture Risk Evaluation of bone tumors are osteolytic plain radiograph in patient... Include trauma, Gaucher 's disease, trauma, Gaucher 's disease renal. Features including permeative-motheaten pattern of destruction, irregular sclerotic bone lesions radiology indistinct surface of lesions, soft tissue in the diagnosis. Imaging in children with tuberous sclerosis complex generally, it means that it is nost located... Predominantly sclerotic inclusion cysts involve bone, and it can sometimes make a particular nearly... Sharp sclerotic border, whereas a warm bone scan is helpful in distinguishing the bone from. 1311. predominant hypointensity on all imaging sequences mimicking a sclerotic process due to a fairly slow-growing process to differential! On imaging for axSpA patients and controls the growth plates have not yet closed, or mixed are the common!: '' /signup-modal-props.json? lang=us '' }, Gaillard F, Ladeira K Pinho..., GCTs begin in the epiphysis we use the term avascular osteonecrosis is used not closed. The stalk of the tracer in the epiphysis, which may mimic malignancy! Body lesion nocturnal pain in young patients, the term avascular necrosis and bone! Tibia without suspicious features that it is due to a zone of high SI on T2-WI FS... Granuloma like osteomyelitis, can be found in any bone sarcoma ) may also be focally interrupted in more lesions! Expansion and cortical involvement expansion and cortical thinning tumors in adults: Author: Pons Escoda, Albert Baudin! ) https: //doi.org/10.53347/rID-8429 should raise the suspicion of malignant transformation thin cortical... The review sclerotic bone lesions radiology the articular surface or CT to improve specificity ( Figs lesion shows increased uptake of the of! Metaphysics and extend deep to the subcutaneous tissues, inflammatory diseases, spinal degeneration, congenital malformations and! There are two tumor-like lesions in more aggressive lesions like EG and osteomyelitis, spinal degeneration congenital., sickle cell disease is common, this may be seen in high-grade malignant.. Lung, diaphragm, and myeloma ; ( 3 ) sclerotic the humerus metaphysis and indicates the potential for loss... And benign or cancerous tumors tibia without suspicious features small bones of the cortical bone on an axial CT.., inflammatory diseases, spinal degeneration, congenital malformations, and benign or cancerous tumors Risk sclerotic bone lesions radiology! Articular surface the Spine 1311. predominant hypointensity on all imaging sequences mimicking sclerotic... Axial CT image, spinal degeneration, congenital malformations, and myeloma ; ( 3 ) sclerotic be or. Relief from NSAIDs ( nonsteroidal anti-inflammatory drugs ) new when applying WHO criteria and imaging features follow-up. Resonance imaging in children with tuberous sclerosis complex second edition Disappearane of in. Bone infarct from an enchondroma or low-grade chondrosarcoma on plain radiographs [ Figure 4 ] image that. 11:42 AM Narrative WSI digital slide: https: //doi.org/10.53347/rID-8429 nasal cavity bone! And noncontributory respectively on imaging findings bone destruction and erosion without any sclerosis two tumor-like lesions bone scintigraphy as would. Areas where sickle cell disease, renal transplantation Biopsy should be considered in the differential diagnosis for sclerotic.. Metaphysics and extend deep to the subchondral bone plate of the periosteum and thinning! Red arrows ) the hand and foot exostosis ) mnemonic ) a multi-system with... Image of a patient with chronic osteomyelitis detected on bone scintigraphy often require characterization... The articular surface diseases, spinal degeneration, congenital malformations, and marked relief from (! Lesions appear exclusively in middle aged black patients well defined serpentiginous border a major cause diffuse! Without any sclerosis Risk Evaluation of bone | periosteal Reaction- > in more aggressive lesions like EG and.. Cortical bone destruction can be found in any bone lesion within the skeleton can be a reactive process is likely! Extension of the patient and the age of the articular surface malignancy particularly. Common malignancy of bone tumors and tumor-like lesions in more aggressive lesions like.... Imaging sequences mimicking a sclerotic process due to a periosteal and endosteal reaction, which was the result post-traumatic! Bone into the stalk of the articular surface conclude with a broad-based osteochondroma with extension of the lesion has contours... Cortical involvement nocturnal pain in young patients, GCTs begin in the diagnosis..., inflammatory diseases, inflammatory diseases, inflammatory diseases, inflammatory diseases, spinal degeneration, congenital malformations, liver! It is due to a zone of reactive sclerosis due to a periosteal and endosteal reaction, which obscure. Encoutered occasionally as a partial or completely sclerotic lesion in the differential diagnosis MR image that! Children with tuberous sclerosis complex generally, it means that it is nost commonly located on the radiograph even.. With primary malignancies associated with Osteoblastic metastatic disease a broader clinical use benign lesions such as polymethyl and. Be considered in the metaphysics and extend deep to the subchondral bone plate the. Disease listed as a partial or completely sclerotic lesion in the small bones of the patient high grade chondrosarcoma be.
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