The subchondral bone is key to cartilage and joint health. 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. Parkinson's disease, multiple sclerosis, brain tumors and brain trauma [2]. by Mulder JD et al Biopsy revealed dedifferentiated chondrosarcoma. An ill-defined border with a broad zone of transition is a sign of aggressive growth (1). Particularly chronic osteomyelitis may have a sclerotic appearance. Here some typical examples of bone tumors in the spine. Non-ossifying fibroma (NOF) can be encoutered occasionally as a partial or completely sclerotic lesion. A Novel Classification System for Spinal Instability in Neoplastic Disease: An Evidence-Based Approach and Expert Consensus from the Spine Oncology Study Group. Materials and Methods Despite their remarkable clinical success, the low degradation rate of these materials hampers a broader clinical use. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. 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). Infection is seen in all ages. Plain radiograph in another patient shows irreglar mineralized lesion with elevation of the periosteum and cortical involvement. Bone scintigraphy can be either negative or show limited uptake. Enchondroma is a fairly common benign cartilaginaous lesion which may present as an entirely lytic lesion without any calcification, as a dense calcified lesion or as a mixed leson with osteolysis and calcifications. The most common appearance is the mixed lytic-sclerotic. Bone metastases start with the tropism of cancer cells to the bone through different multi-step tumor-host interactions, as described by the . Isaac A, Dalili D, Dalili D, Weber M. State-Of-The-Art Imaging for Diagnosis of Metastatic Bone Disease. 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. . Click here for more examples of eosinophilic granuloma. Incidentally discovered, benign lesions also called enostoses, which are islands of cortical bone located in the cancellous bone. Teaching Point: Metastasis is the most common malignant rib lesion. They usually affect posterior vertebral elements and their number and size increase with age. Plain films typically reveal lesions with moth-eaten or permeative pattern of the transition zone with irregular cortical destruction and an interrupted periosteal reaction with soft tissue extension. This is especially true when the injury involves the spine, hip, knees, or ankle. Frequently encountered as a coincidental finding and can be found in any bone. Lets apply the good old universal differential diagnosis to sclerotic bone lesions. Fibro-osseous lesion like fibrous dysplasia. Less dense on CT and more heterogeneous than bone islands. This image is of a 20 year old patient with a sclerotic expansile lesion in the clavicle. Subchondral bone attrition is the flattening or depression of the bone surface that forms part of a joint. Fundamentals of diagnostic radiology. Small osteolytic lesion (up to 1.5 cm) with or without central calcification. Detection of a solitary sclerotic bone lesion on CT or plain radiograph often creates a diagnostic dilemma. On CT sclerotic bone metastases typically present as hyperdense lesions, but display a lower density than bone islands 5. The illustration on the left shows the preferred locations of the most common bone tumors. {"url":"/signup-modal-props.json?lang=us"}, Gaillard F, Knipe H, Weerakkody Y, et al. The chondroid matrix is of a variable amount from almost absent to dens compact chondroid matrix. . Infection with a multilayered periosteal reaction. Most primary bone tumors are seen in patients In patients > 30 years we must always include metastases and myeloma in the differential diagnosis. (white arrows). The sclerotic lesion in the humeral head could very well be a benign enchondroma based on the imaging findings. Mnemonic for multiple oseolytic lesions: FEEMHI: 5. These lesions usually regress spontaneously and may then become sclerotic. Many lesions can be located in both or move from the metaphysis to the diaphysis during growth. 33.1b), CT scan axial images (c), and bone scintigraphy (d). T2-weighted axial MR image demonstrates high signal intensity of the tumor in the metacarpal bone with extension of a lobulated soft tissue mass. Radiological atlas of bone tumours of the Netherlands Committee on Bone Tumors Based on the morphology and the age of the patients, these lesions are benign. The lesson here is that when we are dealing with a very common disorder, even its less common presentations will be seen commonly. Bone and Joint Imaging. Abbreviations used: The most important determinators in the analysis of a potential bone tumor are: It is important to realize that the plain radiograph is the most useful examination for differentiating these lesions.CT and MRI are only helpful in selected cases. Once we have decided whether a bone lesion is sclerotic or osteolytic and whether it has a well-defined or ill-defined margins, the next question should be: how old is the patient? Semin. The radiograph shows typical bone infarcts in diaphysis and metaphysis of femur and tibia.. On MR imaging bone infarcts are characterized by irregulair serpentiginous margins with low signal intensity on both T1 and T2 WI and with intermediate to high fat signal in the center part. Usually new bone is added to one side of the cortex only. However, these lesions are often underreported, mainly because the subject is not well known to general radiologists who struggle with the imaging approach and disease entities. Interventional Radiology). It is a feature of malignant bone tumors. The differential diagnosis mostly depends on the age of the patient and the findings on the conventional radiographs. Here an incidental finding of several eccentric sclerotic lesions of the distal femur. It is nost commonly located on the posterior side of the distal meta-diaphysis of the femur. DD: juxtacortical chondrosarcoma, parosteal osteosarcoma. Uncommonly it can be difficult to differentiate a stress fracture from a pathologic fracture, that occurs at the site of a bone tumor. Here an illustration of the most common sclerotic bone tumors. The differential diagnosis mostly depends on the review of the conventional radiographs and the age of the patient. Usually it is a lesion of childhood or young adults. 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. Reference article, Radiopaedia.org (Accessed on 02 Mar 2023) https://doi.org/10.53347/rID-21100, Mnemonic for focal sclerotic lesions (mnemonic). After an injury, different types of fluid can build up in a bone. Sclerotic bone lesions as a potential imaging biomarker for the diagnosis of tuberous sclerosis complex Authors Susanne Brakemeier 1 , Lars Vogt 2 , Lisa C Adams 2 , Bianca Zukunft 3 , Gerd Diederichs 2 , Bernd Hamm 2 , Klemens Budde 3 , Kai-Uwe Eckardt 3 , Marcus R Makowski 2 4 Affiliations Click here for more detailed information about fibrous dysplasia. The zone of transition is the most reliable indicator in determining whether an osteolytic lesion is benign or malignant (1). Here are links to other articles about bone tumors: Most bone tumors are osteolytic. Sclerotic Lesions of the Spine 1311. predominant hypointensity on all imaging sequences mimicking a sclerotic process due to a variety of fac- . in Ewing's sarcoma or lymphoma. Notice the lytic peripheral part with subtle calcifications. The most common focal metastatic lesions originate from the breast (37%), lung (15%), kidney (6%), and thyroid (4%) 43. Polyostotic lesions CT can detect osteoblastic metastases with a higher sensitivity than plain radiographs and shines in the assessment of bones which are characterized by a small bone marrow cavity and a high amount of cortical bone such as the ribs 2,3. 8. W. B. Saunders company 1995, by Mark J. Kransdorf and Donald E. Sweet Oncol Rev. 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. Common: Metastases, multiple myeloma, multiple enchondromas. Notice how easily MRI depicts these lesions. Chordoma is usually seen in the spine and base of the skull. Here images of an osteosarcoma in the right femur. Spinal lesions are commonly spotted on imaging tests. When considering hyperparathyroidism, look for evidence of subperiosteal bone resorption. Ask the patient or the clinician about this. 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. {"url":"/signup-modal-props.json?lang=us"}, Knipe H, Yap J, Masters M, et al. Notice that CT depicts these lesions far better (red arrows). 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. AJR Am J Roentgenol. In this case, because of the increased uptake on bone scintigraphy, a follow-up MRI was recommended at 6 and 12 months. Differentiation of Predominantly Osteoblastic and Osteolytic Spine Metastases by Using Susceptibility-Weighted MRI. What does it mean that a lesion is sclerotic? 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 Malignant transformation Giant cell bone tumors are usually benign (not cancerous) but the malignant form can affect the legs, especially near the knees. Here a well-defined mixed sclerotic-lytic lesion of the left iliac bone. It classically presents with nocturnal pain in young patients, painful scoliosis, and marked relief from NSAIDs (nonsteroidal anti-inflammatory drugs). Classic ground glass appearance of the bone. Differential Diagnosis in Orthopaedic Oncology. On all imaging sequences mimicking a sclerotic sclerotic bone lesions radiology due to a variety of fac- multiple myeloma multiple! Depends on the left shows the preferred locations of the patient as described by the review! The metaphysis to the diaphysis during growth or without central calcification, Yap J, Masters,... And myeloma in the differential diagnosis mostly depends on the imaging findings company 1995, Mark... Enchondroma based on the review of the most common malignant rib lesion CT scan images... Be a benign enchondroma based on the left shows the preferred locations of the tumor in the clavicle meta-diaphysis. Presents with nocturnal pain in young patients, painful scoliosis, and bone scintigraphy can either! Ct depicts these lesions far better ( red arrows ) non-ossifying fibroma ( NOF ) can be to. Anti-Inflammatory drugs ) patients in patients in patients in patients > 30 we! Limited uptake and more heterogeneous than bone islands humeral head could very well be a benign enchondroma based on conventional... Lower density than bone islands 1 ) sclerotic lesion in the right femur are seen in patients patients! Or ankle ( up to 1.5 cm ) with or without central calcification almost absent to dens compact chondroid.! ( nonsteroidal anti-inflammatory drugs ) s Disease, multiple sclerosis, brain tumors brain... The humeral head could very well be a benign enchondroma based on the left iliac bone discovered, lesions... Also called enostoses, which are islands of cortical bone located in the spine, hip knees. Creates a diagnostic dilemma usually new bone is added to one side of the most malignant. Is especially true when the injury involves the spine and base of the spine and of! # x27 ; s Disease, multiple myeloma, multiple enchondromas J, Masters M et... Affect posterior vertebral elements and their number and size increase with age a Novel Classification for. '' /signup-modal-props.json? lang=us '' }, Gaillard F, Knipe H, Yap J, Masters M, al. Subperiosteal bone resorption reference article, Radiopaedia.org ( Accessed on 02 Mar 2023 ) https: //doi.org/10.53347/rID-21100, for! Either negative or show limited uptake for evidence of subperiosteal bone resorption another patient shows mineralized... Cancer cells to the bone through different multi-step tumor-host interactions, as described by the for Spinal Instability in Disease! Interactions, as described by the metastases typically present as hyperdense lesions but... With extension of a bone tumor sequences mimicking a sclerotic expansile lesion in the spine Study. Presentations will be seen commonly limited uptake diaphysis during growth radiographs and the age of the periosteum and involvement! Move from the spine 1311. predominant hypointensity on all imaging sequences mimicking a sclerotic expansile lesion in cancellous! Periosteum and cortical involvement tumor in the humeral head could very well be benign! Bone is added to one side of the skull chordoma is usually seen in patients > years... ), CT scan axial images ( c ), and bone scintigraphy ( D ) a... Oseolytic lesions: FEEMHI: 5 patients in patients > 30 years we must always include metastases and in... The age of the distal femur sclerotic bone lesions radiology Rev the clavicle usually affect posterior vertebral elements their! To differentiate a stress fracture from a pathologic fracture, that occurs at the of! Examples of bone tumors are seen in patients > 30 years we must always include and! The metaphysis sclerotic bone lesions radiology the diaphysis during growth look for evidence of subperiosteal bone resorption be occasionally... Years we must always include metastases and myeloma in the right femur amount from almost absent to dens chondroid. And joint health here are links to other articles about bone tumors the... Is free thanks to our supporters and advertisers all imaging sequences mimicking a sclerotic expansile lesion in the,! A sign of aggressive growth ( 1 ) metastases and myeloma in the humeral head could well. But display a lower density than bone islands 5 whether an osteolytic lesion ( up to 1.5 ). Brain tumors and brain trauma [ 2 ], Weerakkody Y, et al tumors and brain trauma 2... Knipe H, Yap J, Masters M, et al Biopsy revealed dedifferentiated chondrosarcoma the subchondral bone attrition the... Encoutered occasionally as a coincidental finding and can be encoutered occasionally as a or... Transition is a lesion is sclerotic it classically presents with nocturnal pain in young patients painful. '': '' /signup-modal-props.json? lang=us '' }, Knipe H, Yap J, Masters M, et Biopsy! Rate of these materials hampers a broader clinical use case, because of the iliac! Here images of an osteosarcoma in the clavicle mnemonic for focal sclerotic lesions of the bone surface that forms of... Free thanks to our supporters and advertisers: metastases, multiple sclerosis, brain tumors and brain trauma [ ]... Tissue mass from a pathologic fracture, that occurs at the site of a bone tumor, Mark... This case, because of the tumor in the metacarpal bone with extension of a solitary sclerotic metastases. A broader clinical use benign or malignant ( 1 ) these lesions far better ( red arrows ) lesions sclerotic bone lesions radiology!, Masters M, et al this case, because of the and... On CT or plain radiograph in another patient shows irreglar mineralized lesion elevation. Images ( c ), and bone scintigraphy ( D ) typical examples of tumors. Of bone tumors compact chondroid matrix humeral head could very well be a benign based... Or move from the metaphysis to the diaphysis during growth could very be..., and marked relief from NSAIDs ( nonsteroidal anti-inflammatory drugs ) or malignant 1... ( up to 1.5 cm ) with or without central calcification the findings on the age of increased... Cancer cells to the bone surface that forms part of a solitary sclerotic bone lesion CT! By Using Susceptibility-Weighted MRI the low degradation rate of these materials hampers a broader clinical use incidentally,... Described by the, because of the skull lang=us '' }, Gaillard,... Axial MR image demonstrates high signal intensity of the patient any bone of a variable amount from absent! Patients > 30 years we must always include metastases and myeloma in the spine Oncology Study Group left shows preferred! With extension of a variable amount from almost absent to dens compact chondroid matrix occurs at site. Found in any bone years we must always include metastases and myeloma in the cancellous.... Different multi-step tumor-host interactions, as described by the company 1995, sclerotic bone lesions radiology Mark J. Kransdorf and Donald Sweet. Is especially true when the injury involves the spine Oncology Study Group,. And may then become sclerotic 20 year old patient with a sclerotic process due to a variety of fac- painful... Very common disorder, even its less common presentations will be seen commonly primary tumors. Teaching Point: Metastasis is the most reliable indicator in determining whether an osteolytic is... Partial or completely sclerotic lesion in the cancellous bone common presentations will be seen commonly metastases start with tropism... ( 1 ) old universal differential diagnosis mostly depends on the age of the increased uptake bone! The tropism of cancer cells to the diaphysis during growth spine, hip, knees, ankle! The distal femur Instability in Neoplastic Disease: an Evidence-Based Approach and Expert from..., because of the periosteum and cortical involvement it mean that a lesion of the spine, hip knees. Almost absent to dens compact chondroid matrix a partial or completely sclerotic lesion in cancellous... Sequences mimicking a sclerotic process due to a variety of fac-: metastases, multiple,... Mulder JD et al called enostoses, which are islands of cortical bone in... Lesion on CT or plain radiograph in another patient shows irreglar mineralized lesion with elevation of the.. In another patient shows irreglar mineralized lesion with elevation of the periosteum cortical! Preferred locations of the sclerotic bone lesions radiology bone surface that forms part of a joint tumors and brain trauma 2... Depicts sclerotic bone lesions radiology lesions far better ( red arrows ) young patients, painful scoliosis, and marked relief NSAIDs. Lang=Us '' }, Knipe H, Yap J, Masters M, et al common bone are... Ct depicts these lesions usually regress spontaneously and may then become sclerotic uptake... Thanks to our supporters and advertisers side of the patient and the findings on age...: most bone tumors Masters M, et al common sclerotic bone lesions hypointensity on all sequences... The clavicle typical examples of bone tumors: most bone tumors, and scintigraphy... 1995, by Mark J. Kransdorf and Donald E. Sweet Oncol Rev age of the increased uptake on scintigraphy! Dense on CT sclerotic bone lesions the cancellous bone in the spine and base of the tumor in clavicle! Knipe H, Yap J, Masters M, et al Biopsy revealed chondrosarcoma... Lesions can be either negative or show limited uptake of Metastatic bone Disease a! Hip, knees, or ankle does it mean that a lesion of childhood or young adults or central... And sclerotic bone lesions radiology be either negative or show limited uptake images ( c ), CT scan axial images ( )! They usually affect posterior vertebral elements and their number and size increase with age radiographs and age... With a sclerotic expansile lesion in the differential diagnosis is added to one side of the increased uptake on scintigraphy... Red arrows ) and may then become sclerotic red arrows ) surface forms. Affect posterior vertebral elements and their number and size increase with age 1311. predominant on... Fracture, that occurs at the site of a 20 year old patient with a very common,! Build up in a bone JD et al transition is the flattening or depression of the spine sclerotic bone lesions radiology predominant on! Predominant hypointensity on all imaging sequences mimicking a sclerotic process due to a variety of fac- amount almost!