In the late stage of OA, the main feature is subchondral bone sclerosis, whose microarchitectural characteristics are elevated apparent density, increased bone volume, . Growth of osteochondromas at adult ages, which is characterized by a thick cartilaginous cap (high SI on T2WI) should raise the suspicion of progression to a peripheral chondrosarcoma. Top five location of bone tumors in alphabethic order: Aneurysmal Bone Cyst -tibia, femur, fibula, spine, humerusAdamantinoma -tibia shaft, mandibleChondroblastoma -femur, humerus, tibia, tarsal bone (calc), patellaChondromyxoid fibroma - tibia, femur, tarsal bone, phalanx foot, fibulaChondrosarcoma - femur, rib, iliac bone, humerus, tibiaChordoma -sacrococcygeal, spheno-occipital, cervical, lumbar, thoracicEosinophilic Granuloma -femur, skull, iliac bone, rib, vertebraEnchondroma -phalanges of hands and feet, femur, humerus, metacarpals, ribEwing's sarcoma - femur, iliac bone, fibula, rib, tibiaFibrous dysplasia - femur, tibia, rib, skull, humerusGiant Cell Tumor - femur, tibia, fibula, humerus, distal radiusHemangioma - spine, ribs, craniofacial bones, femur, tibiaLymphoma - femur, tibia, humerus, iliac bone, vertebraMetastases - vertebrae, ribs, pelvis, femur, humerusNon Ossifying Fibroma - tibia, femur, fibula, humerusOsteoid osteoma - femur, tibia, spine, tarsal bone, phalanxOsteoblastoma - spine, tarsal bone (calc), femur, tibia, humerusOsteochondroma - femur, humerus, tibia, fibula, pelvisOsteomyelitis - femur, tibia, humerus, fibula, radiusOsteosarcoma -femur, tibia, humerus, fibula, iliac boneSolitary Bone Cyst -proximal humerus, proximal femur, calcaneal bone, iliac bone. In the article Bone Tumors - Differential diagnosis we discussed a systematic approach to the differential diagnosis of bone tumors and tumor-like lesions. Complete envelopment may occur. AJR 2005; 185:915-924. Our patient had lytic bone lesions in (femur) long bones and also sclerotic lesions in the pelvic which was . W. B. Saunders company 1995, by Mark J. Kransdorf and Donald E. Sweet 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. Multiple enchondromas and hemangiomas are seen in Maffucci's syndrome. Accordingly, growth of osteochondromas is allowed until a patient reaches adulthood and the physeal plates are closed. Distinct phenotypes are described: osteoblastic, the more common osteolytic and mixed. W. B. Saunders company 1995, by Mark J. Kransdorf and Donald E. Sweet Sclerosis can also be reactive, e.g. Here, we showed that sBT values are higher in patients presenting 496 with bone loss . Osteopetrosis and pyknodysostosis are likewise hard to mistake for other entities since the bones are denser than in any other disorder, and the long bones tend to have very tiny medullary canals. 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"}. The bone marrow compartment is not involved which is important for the surgical strategy. Consider progression of osteohondroma to chondrosarcoma when cartilage cap measures > 10 mm. Localisation: femur, tibia, hands and feet, spine (arch). Check for errors and try again. Hereditary sclerosing bone dysplasias result from some disturbance in the pathways involved in osteoblast or osteoclast regulation, leading to abnormal accumulation of bone. Contact Information and Hours. Amsterdam: Elsevier, 1993. 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. Ewing sarcoma with lamellated and focally interrupted periosteal reaction. Plain radiograph in another patient shows irreglar mineralized lesion with elevation of the periosteum and cortical involvement. Radiologe. Large lesions tend to expand into both areas. They usually affect posterior vertebral elements and their number and size increase with age. More heterogenous and irregular with bony trabecular destruction and possible extension beyond the confines of the cortex. Usually stress fractures are easy to recognize. 2010;35(22):E1221-9. Mnemonic for multiple oseolytic lesions: FEEMHI: 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. Fibrous dysplasia, enchondromas, EG, Mets and myeloma, Hyperparathyroidism, Infection. Mineralization in osteoid tumors can be described as a trabecular ossification pattern in benign bone-forming lesions and as a cloud-like or ill-defined amorphous pattern in osteosarcomas. Here a rather wel-defined eccentric lesion which is predominantly sclerotic. 1. Skeletal Radiol. Patients with sclerotic lesions due to metastasis often have a history of prior malignant disease. by Mulder JD et al (A) Small radiolucent lesion exhibiting a thin sclerotic border (arrow) is present in the lateral cortex of the distal tibia of a 13-year-old boy. A sclerotic lesion is an unusual hardening or thickening of your bone. 2017;11(1):321. Causes include trauma, infection, autoimmune diseases, inflammatory diseases, spinal degeneration, congenital malformations, and benign or cancerous tumors. Sclerotic means that the lesions are slow-growing changes to your bone that happen very gradually over time. These are infections and eosinophilic granuloma. 105-118. 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. Here an illustration of the most common sclerotic bone tumors. Stress fractures occur in normal (fatigue fractures) or metabolically weakened (insufficiency fractures) bones. Notice the numerous ill-defined osteoblastic metastases. Consider peripheral chondrosaroma in growing osteochondromas with or without pain after closure of the physeal plate. Another approach to the differential diagnosis of sclerotic bone lesions is to use the mnemonic I VINDICATE, which means 'I clear myself from accusation'. The illustration on the left shows the preferred locations of the most common bone tumors. Notice the numerous predominantly osteoblastic metastases. Here a radiograph of the pelvis with a barely visible osteoblastic metastasis in the left iliac bone (blue arrow). 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. 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 2021;50(5):847-69. Both imaging modalities achieved only a moderate correlation with DEXA. 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). Calcifications in chondroid tumors have many descriptions: rings-and-arcs, popcorn, focal stippled or flocculent. (2007) ISBN:0781765188. 1988;17(2):101-5. RT @JMGardnerMD: 20 yo M w/ 5 cm lytic bone lesion in proximal tibia metaphysis, sharply demarcated w/ sclerotic rim. Osteoid matrix in osseus tumors like osteoid osteomas and osteosarcomas. You can then customize the above differential for whichever pattern of sclerosis that you see. 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. Here images of a patient with prostate cancer. I think that the best way is to start with a good differential diagnosis for sclerotic bones. Growth has been demonstrated well after skeletal maturity. Donald Resnick, Mark J. Kransdorf. Confavreux C, Follet H, Mitton D, Pialat J, Clzardin P. Fracture Risk Evaluation of Bone Metastases: A Burning Issue. Generally, this just follows common sense some lesions should logically be expected to be focal, others multifocal, and yet others diffuse or systemic. Hallmark of osteosarcoma is the production of bony matrix, which is reflected by the sclerosis seen on the radiograph. 10. growth of osteohondroma in skeletally mature patients, irregular or indistinct surface of lesions, soft tissue mass with scattered or irregular calcifications. This part corresponds to a zone of high SI on T2-WI with FS on the right. Sclerotic osteoblastic metastases must be included in the differential diagnosis of any sclerotic bone lesion in a patient > 40 years. 1. (2007) ISBN: 9780781779302 -. 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. It classically presents with nocturnal pain in young patients, painful scoliosis, and marked relief from NSAIDs (nonsteroidal anti-inflammatory drugs). There are two patterns of periosteal reaction: a benign and an aggressive type. Imaging of skull vault tumors in adults: Author: Pons Escoda, Albert Naval Baudin, Pablo . Sclerotic or osteoblastic bone metastases are distant tumor deposits of a primary tumor within bone characterized by new bone deposition or new bone formation. 6. WSI digital slide: https://kikoxp.com/posts/4606. About Us; Staff; Camps; Scuba. Notice that the cortical bone extends into the lesion. 1. Resonance Imaging Saeed M. Bafaraj . Sclerotic bone lesions are commonly detected by abdominal MRI in children with tuberous sclerosis complex. The most reliable indicator in determining whether these lesions are benign or malignant is the zone of transition between the lesion and the adjacent normal bone (1). Disappearane of calcifications in a pre-existing enchondroma should raise the suspicion of malignant transformation. In this case, because of the increased uptake on bone scintigraphy, a follow-up MRI was recommended at 6 and 12 months. Solitary sclerotic bone lesion. You may have been surprised to see metastatic disease listed as a leading cause for diffuse sclerotic bones. Ossification in parosteal osteosaroma is usually more mature in the center than at the periphery. Multiple enchondromas are seen in Morbus Ollier. 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. 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. Occasionally slowly enlargement can be seen. Sclerotic bone metastases. Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. The contour of the involved bone is usually normal or with mild expansive remodelling. The lesion is predominantly calcified. CT of Sclerotic Bone Lesions: Imaging Features Differentiating Tuberous Sclerosis Complex with Lymphangioleiomyomatosis from Sporadic Lymphangioleiomymatosis1. Most of the time, sclerotic lesions are benign. Check for errors and try again. In patients > 30 years, and particularly > 40 years, despite benign radiographic features, a metastasis or plasmacytoma also have to be considered Enchondroma, the most commonly encountered lesion of the phalanges. Interventional Radiology). Most bone tumors are solitary lesions. Halo of increased signal on T2 W images about the low signal central lesion is suggestive of metastatic disease. Notice that in all three patients, the growth plates have not yet closed. Clin Orthop Relat Res. D'Oronzo S, Coleman R, Brown J, Silvestris F. Metastatic Bone Disease: Pathogenesis and Therapeutic Options. There are two tumor-like lesions which may mimic a malignancy and have to be included in the differential diagnosis. 3. Here an example of a patient with a stress fracture of the distal fibula. The major part of the lesion consists of reactive sclerosis. At the 1-year follow-up, the lesion was completely stable and no additional follow-up was recommended in the absence of symptoms. In breast cancer, metastases may present as lytic lesions that may become sclerotic expressing a favourable response to chemotherapy. Osteoblastic metastases (2) Matching the degradation rate of the materials with neo bone formation remains a challenge for bone-repairing materials. Notice the resemblance to a juxtacortical mass in another patient (right), which was a biopsy proven parosteal osteosarcoma. Osteomyelitis is a mimicker of various benign and malignant bone tumors and reactive processes that may be accompanied by reactive sclerosis. This is opposed to myositis ossificans which may present very close to the cortical bone, but maturation develops from the center to the periphery. AJR Am J Roentgenol. The epiphysis, metaphysis and diaphysis may be involved. Mirels H. Metastatic Disease in Long Bones: A Proposed Scoring System for Diagnosing Impending Pathologic Fractures. 2021;216(4):1022-30. There are no calcifications. Most primary bone tumors are seen in patients In patients > 30 years we must always include metastases and myeloma in the differential diagnosis. Subchondral bone attrition is the flattening or depression of the bone surface that forms part of a joint. Eosinophilic granuloma like osteomyelitis, can be a serious mimicker of malignancy (particularly Ewing sarcoma). 11. 1 When the vertebral lesion has no benign features, especially in the older adult patient, metastatic disease is always a significant consideration. Coronal T1W image shows lobulated margins and peripheral low SI due to the calcifications. {"url":"/signup-modal-props.json?lang=us"}, Yap K, Knipe H, Niknejad M, et al. Diffuse bony sclerosis (mnemonic). The differential for multifocal lesions happens to be identical to that for focal lesions. 4. {"url":"/signup-modal-props.json?lang=us"}, Knipe H, Yap J, Masters M, et al. There is reactive sclerosis with a nidus that is barely visible on the radiograph (blue arrow), but clearly visible on the CT (red arrows). 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That for focal lesions hands and feet, spine ( arch ) stress Fracture of the sclerotic bone lesions radiology completely... K, Knipe H, Mitton D, Pialat J, Silvestris F. metastatic bone:... Lesions are benign for sclerotic bones raise the suspicion of malignant transformation: rings-and-arcs, popcorn, stippled. Correlation with DEXA mineralized lesion with elevation of the lesion et al various benign and an aggressive type metaphysis diaphysis! Of any sclerotic bone lesions radiology bone tumors been surprised to see metastatic disease listed a... Osteochondromas with or without pain after closure of the distal fibula sclerotic in! A joint lesions of bone | periosteal Reaction- > ) Matching the degradation rate of the most sclerotic... To chemotherapy as lytic lesions that may be accompanied by reactive sclerosis presenting 496 with bone loss arch!