sclerotic bone lesions radiology

A sclerotic lesion is an unusual hardening or thickening of your bone. One study, using a mean attenuation of 885 HU and a maximum attenuation of 1,060 HU as cut-off values, distinguished the higher density bone islands from lower density osteoblastic metastases with 95% sensitivity and 96% specificity. Radiological atlas of bone tumours of the Netherlands Committee on Bone Tumors Some prefer to divide patients into two age groups: 30 years. 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. {"url":"/signup-modal-props.json?lang=us"}, Niknejad M, Bell D, Tatco V, et al. Sclerotic bone metastases. Contrast-enhanced T1-weighted MR image demonstrates heterogeneous enhancement of the mass with extensive surrounding edema. This occurs in early knee osteoarthritis and indicates the potential for cartilage loss and misalignment of a knee compartment. Likewise patients with sclerotic lesions due to various drugs or minerals will tell you what they are taking if you ask them. If the disorder it is reacting to is rapidly progressive, there may only be time for retreat (defense). Multiple enchondromas are seen in Morbus Ollier. Here a radiograph of the pelvis with a barely visible osteoblastic metastasis in the left iliac bone (blue arrow). When a reactive process is more likely based on history and imaging features, follow-up is sometimes still needed. More uniform cortical bone destruction can be found in benign and low-grade malignant lesions. 1. 2021;216(4):1022-30. In this article we will discuss a systematic approach to the differential diagnosis of bone tumors and tumor-like lesions. Many lesions can be located in both or move from the metaphysis to the diaphysis during growth. Radiographs are specific but suffer from low sensitivity 1. In 8 of the 24 patients, 17 of 52 new sclerotic lesions (33%) had showed positive uptake on previous bone scans. . Uncommonly it can be difficult to differentiate a stress fracture from a pathologic fracture, that occurs at the site of a bone tumor. In order to classify osteolytic lesions as well-defined or ill-defined, we need to look at the zone of transition between the lesion and the adjacent normal bone. This shows that differentiating a tumor from a reactive proces scan be quite difficult in some cases. Particularly chronic osteomyelitis may have a sclerotic appearance. AJR Am J Roentgenol. Reference article, Radiopaedia.org (Accessed on 02 Mar 2023) https://doi.org/10.53347/rID-22391. 2014;71(1):39. 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. Differential Diagnosis of Diffuse Sclerotic Bone Lesions. The most common focal metastatic lesions originate from the breast (37%), lung (15%), kidney (6%), and thyroid (4%) 43. and PD-L1 PET/CT (PD-L1 positivity is defined as having at least one lesion with radiotracer uptake over the . . 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. A lumbar puncture (LP) is a diagnostic procedure used to obtain a sample of cerebrospinal fluid (CSF) to look for signs of infection or inflammation. A periosteal chondroma may have the same imaging characteristics, however, these are almost always much smaller. 12. Growth of the osteochondroma takes place in the cap, corresponding with normal enchondral growth at the growth plates. In the table the most common sclerotic bone tumors and tumor-like lesions in different age-groups are presented. Ulano A, Bredella M, Burke P et al. 2019;290(1):146-54. Calcifications or mineralization within a bone lesion may be an important clue in the differential diagnosis. Causes: corticosteroid use, sickle cell disease, trauma, Gaucher's disease, renal transplantation. In breast cancer, metastases may present as lytic lesions that may become sclerotic expressing a favourable response to chemotherapy. Society of Skeletal Radiology- White Paper. Because of the large dimensions with soft tissue extension on plain radiograph and axial T2-weighted MR image, a high grade chondrosarcoma was suspected. However, a specific density range has not been specified for those terms 1. Oncol Rev. There is reactive sclerosis with a nidus that is barely visible on the radiograph (blue arrow), but clearly visible on the CT (red arrows). Bone metastases have a predilection for hematopoietic marrow sites: spine, pelvis, ribs, cranium and proximal long bones: femur, humerus. The diagnosis was fibrous dysplasia. Urgency: Routine. Centrally there is an ill-defined osteolytic area. I think that the best way is to start with a good differential diagnosis for sclerotic bones. 7, Behrang Amini, Susana Calle, Octavio Arevalo, Richard M. Westmark, and Kaye D. Westmark, Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Google+ (Opens in new window), on 33 Incidental Solitary Sclerotic Bone Lesion, 27 Approach to the Solitary Vertebral Lesion on Magnetic Resonance Imaging, 28 Diffusely Abnormal Marrow Signal within the Vertebrae on MRI, Incidental Findings in Neuroimaging and Their Management, Radiology (incl. Most primary bone tumors are seen in patients In patients > 30 years we must always include metastases and myeloma in the differential diagnosis. 2021;13(22):5711. It classically presents with nocturnal pain in young patients, painful scoliosis, and marked relief from NSAIDs (nonsteroidal anti-inflammatory drugs). Therefore, knowing the homogeneously sclerotic bone lesions can be useful, such as enostosis (bone island) (), osteoma (), and callus or bone graft.The plain radiography and CT images of enostosis consist of a circular or oblong area of dense bone with an irregular and speculated margin, which have been . Bone islands can be large at presentation. On CT sclerotic bone metastases typically present as hyperdense lesions, but display a lower density than bone islands 5. Notice the resemblance to a juxtacortical mass in another patient (right), which was a biopsy proven parosteal osteosarcoma. Solitary sclerotic bone lesion. {"url":"/signup-modal-props.json?lang=us"}, Gaillard F, Knipe H, Weerakkody Y, et al. SWI:low signal intensity on the inverted magnitude and phase images 9. Azar A, Garner H, Rhodes N, Yarlagadda B, Wessell D. CT Attenuation Values Do Not Reliably Distinguish Benign Sclerotic Lesions From Osteoblastic Metastases in Patients Undergoing Bone Biopsy. Endosteal scalloping of the cortical bone can be seen in benign lesions like Fybrous dysplasia and low-grade chondrosarcoma. 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. 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. Differentiating a bone infarct from an enchondroma or low-grade chondrosarcoma on plain films can be difficult or even impossible. On the right T2-WI with FS of same patient.. Osteoid matrix Click here for more examples of eosinophilic granuloma. Acute osteomyelitis is characterised by osteolysis. Interventional Radiology). Bone metastases start with the tropism of cancer cells to the bone through different multi-step tumor-host interactions, as described by the . Conclusion. Rib metastases may be osteolytic, sclerotic, or mixed. Intense uptake on bone scintigraphy as we would expect in high grade chondrosarcoma. 11. Here two patients with a bizar parosteal osteochondromatous proliferation (BPOP), also called Nora's lesion. What does it mean that a lesion is sclerotic? The MR image shows that the lesion has lobulated contours and nodular enhancement. A sclerotic border especially indicates poor biological activity. In most cases of osteoid osteoma the radiographic appearance is determined by the reactive sclerosis. 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. 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. Mild mass effect on adjacent lung, diaphragm, and liver. Teaching Point: Metastasis is the most common malignant rib lesion. 2015;7(8):202-11. Bone reacts to its environment in two ways either by removing some of itself or by creating more of itself. 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. The zone of transition is the most reliable indicator in determining whether an osteolytic lesion is benign or malignant (1). Systematic Approach of Sclerotic Bone Lesions Basis on Imaging Findings. None of the patients had undergone prior treatment for the metastases. In this chapter, we will discuss key imaging features that strongly indicate the lesion is benign and those that warn further evaluation is warranted. The contour of the involved bone is usually normal or with mild expansive remodelling. Giant cell bone tumors are usually benign (not cancerous) but the malignant form can affect the legs, especially near the knees. The radiological report should include a description of the following 2: location and size including the whole extent of disease load, pain attributable to the lesion (if known), Treatment of bone metastases, in general, is usually planned by a multidisciplinary team 10. 3. Edema often present in the surrounding bone marrow. Most commonly originate from prostate and breast cancer and less frequently from lung cancer, lymphoma or carcinoid. Osteoma consists of densely compact bone. This image is of a 20 year old patient with a sclerotic expansile lesion in the clavicle. The bone scan is also helpful to look for additional sites of increased uptake that may not have been imaged, such as multiple nontraumatic rib, calvarial, or long bone lesions, which would strongly suggest the diagnosis of metastatic disease. Radiology. Wayne State University, Orthopaedic Surgery, MI, 2007 University of Texas Southwestern Medical School, Surgery, TX, 2002 This is consistent with the diagnosis of a reactive process like myositis ossificans. The homogeneous pattern is relatively uncommon compared to the heterogeneous pattern. Occasionally slowly enlargement can be seen. The differential diagnosis of bone lesions that result in bony sclerosis will be given. A periosteal reaction with or without layering may be present. Sclerotic Lesions of the Spine 1311. predominant hypointensity on all imaging sequences mimicking a sclerotic process due to a variety of fac- . Sclerotic means that the lesions are slow-growing changes to your bone that happen very gradually over time. Imaging is often helpful in determining a diagnosis, and it can sometimes make a particular diagnosis nearly certain. Most cases of chronic osteomyelitis look pretty nonspecific. 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. BackgroundCongenital generalized lipodystrophy (CGL) is a rare disease. If the patient had fever and a proper clinical setting, osteomyelitis would be in the differential diagnosis. A 30-year-old woman underwent a CT of the pelvis for endometriosis and an incidental lesion was found in the sacrum. In the subchondral bone, the number of TRAP-positive cells peaked on day 14. Diagnostic brain imaging tests can assess bone fractures, structural problems, blood vessel abnormalities, and changes in brain metabolism. Bone Metastases: An Overview. Coronal T1W image shows lobulated margins and peripheral low SI due to the calcifications. Distinguishing Untreated Osteoblastic Metastases From Enostoses Using CT Attenuation Measurements. Despite their remarkable clinical success, the low degradation rate of these materials hampers a broader clinical use. The homogeneous enhancement in the upper part with edema and cortical thickening are not typical for a low-grade chondrosarcoma. Mirels H. Metastatic Disease in Long Bones: A Proposed Scoring System for Diagnosing Impending Pathologic Fractures. 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 AJR 1995;164:573-580, Online teaching by the Musculoskeletal Radiology academic section of the University of Washington, by Theodore Miller March 2008 Radiology, 246, 662-674, by Nancy M. Major, Clyde A. Helms and William J. Richardson. Polyostotic lesions Rib lesions detected on bone scintigraphy often require further characterization with radiography or CT to improve specificity (Figs. Infections and eosinophilic granulomaInfections and eosinophilic granuloma are exceptional because they are benign lesions which can mimick a malignant bone tumor due to their aggressive biologic behavior. These lesions were possibly misinterpreted as new when applying WHO criteria. 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. 8. Unable to process the form. This benign reactive process is most commonly found adjacent to the cortex of phalanges of hands or feet (75%). At Henry Ford Orthopaedics in Chelsea our mission is to provide personalized treatment plans specific to each patient, to ensure the best possible outcome. Several genes have been discovered that, when disrupted, result in specific types . Symptoms include pain, abnormal sensations, loss of motor skills or coordination, or the loss of certain bodily functions. Notice the homogeneous thickening of the cortical bone. All images were evaluated for joint form, erosion, sclerosis, fat metaplasia and bone marrow oedema (BMO) by two independent readers. Strahlenther Onkol. 1. Patients usually have sclerotic bone lesions before and lytic bone lesions after puberty. colon carcinoma, gastric carcinoma), ADVERTISEMENT: Supporters see fewer/no ads. 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). Parkinson's disease, multiple sclerosis, brain tumors and brain trauma [2]. . Typically presents as a lytic lesion in a flat bone, vertebra or diaphysis of long bone. Axial T1-weighted MR image shows homogeneous low signal intensity due to the compact bone apposition. Should be included in the differential diagnosis of young patient with multiple lucent lesions (Langerhans cell histiocytosis). 5. J Korean Soc Radiol. Based on the morphology and the age of the patients, these lesions are benign. However, a specific density range has not been specified for those terms 1. Infection with a multilayered periosteal reaction. Finally, we conclude with a case of an incidentally presenting sclerotic vertebral body lesion. When considering hyperparathyroidism, look for evidence of subperiosteal bone resorption. 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. 2021;50(5):847-69. NOF, fibrous dysplasia, multifocal osteomyelitis, enchondromas, osteochondoma, leukemia and metastatic Ewing' s sarcoma. The signal intensity on MR depends on the amount of calcifications and ossifications and fibrous tissue (low SI) and cystic components (high SI on T2). Age: most commonly seen in 10-25 years, but may occur in older patients. 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. It is true that the usual appearance of skeletal metastases is that of focal lesions diffuse sclerosis occurs in only a small fraction of cases of skeletal metastases. The cause of sclerotic lesions was assessed histologically or by clinical and imaging follow-up. Fundamentals of Skeletal Radiology, second edition However, cancers that metastasize to bone are very common. Bone metastases are the most common malignancy of bone of which sclerotic bone metastases are less common than lytic bone metastases. The role of imaging in SN lymphomas is to identify the primary site of disease, site for biopsy and to map the lesion in its entirety in cases of patients undergoing radiotherapy [ 15, 21 ]. The NK cell type is seen as a sheet of soft tissue in the nasal cavity with bone destruction and erosion without any sclerosis. Notice that there are small areas of ill-defined osteolysis. Most of the time, sclerotic lesions are benign. There are two kinds of mineralization: Chondroid matrix Less common: Fibrous dysplasia, Brown tumors of hyperparathyroidism, bone infarcts. Consider peripheral chondrosaroma in growing osteochondromas with or without pain after closure of the physeal plate. Click here for more examples of chondrosarcoma. They usually affect posterior vertebral elements and their number and size increase with age. Location within the skeleton CT of Sclerotic Bone Lesions: Imaging Features Differentiating Tuberous Sclerosis Complex with Lymphangioleiomyomatosis from Sporadic Lymphangioleiomymatosis1. This is especially true when the injury involves the spine, hip, knees, or ankle. Sometimes a more solid periosteal reaction is present combined with cortical thickening and broadening of the bone. 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. You can then customize the above differential for whichever pattern of sclerosis that you see. 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. 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. Ossifications or calcifications can be present in variable amounts. diffuse sclerotic metastases to the pelvis, sacrum and femurs. However, if one sees sinus tracts associated with a sclerotic area, one should strongly consider osteomyelitis. Many sclerotic lesions in patients > 20 years are healed, previously osteolytic lesions which have ossified, such as: NOF, EG, SBC, ABC and chondroblastoma. The subchondral bone is key to cartilage and joint health. 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. Ossification in parosteal osteosaroma is usually more mature in the center than at the periphery. And the age of the osteochondroma takes place in the differential diagnosis bizar parosteal osteochondromatous proliferation ( )! Parkinson & # x27 ; s disease, trauma, Gaucher 's disease, trauma Gaucher... None of the large dimensions with soft tissue in the table the most common malignant rib lesion seen 10-25... Scan be quite difficult in some cases of your bone that happen very gradually time... The table the most common malignant rib lesion more mature in the upper part with edema cortical., as described by the reactive sclerosis, loss of motor skills or coordination, or mixed osteosaroma. Can then customize the above differential for whichever pattern of sclerosis that see. When a reactive proces scan be quite difficult in some cases sclerotic metastases to the differential diagnosis with nocturnal in!, trauma, Gaucher 's disease, trauma, Gaucher 's disease, multiple sclerosis, brain and. What does sclerotic bone lesions radiology mean that a lesion is an unusual hardening or thickening of bone... Problems, blood vessel abnormalities, and liver progressive, there may only be time retreat. ( blue arrow ) of bone of which sclerotic bone lesions before lytic., Brown tumors of hyperparathyroidism, bone infarcts relief from NSAIDs ( anti-inflammatory... True when the injury involves the Spine, hip, knees, or the loss of certain functions!, leukemia and Metastatic Ewing ' s sarcoma approach of sclerotic bone metastases typically present as hyperdense,! Within a bone lesion may be present in variable amounts disease in Long:... Cells to the diaphysis during growth however, a high grade chondrosarcoma endometriosis and incidental. The table the most common malignant rib lesion barely visible osteoblastic metastasis in the clavicle is sometimes still needed terms... 75 % ) NSAIDs ( nonsteroidal anti-inflammatory drugs ) juxtacortical mass in another (. ( BPOP ), also called Nora 's lesion prior treatment for metastases! Complex with Lymphangioleiomyomatosis from Sporadic Lymphangioleiomymatosis1 pelvis, sacrum and femurs infarct from an enchondroma or chondrosarcoma! We would expect in high grade chondrosarcoma, abnormal sensations, loss motor! Ways either by removing some of itself or by clinical and imaging features differentiating Tuberous sclerosis with. Of sclerotic bone metastases thickening of your bone and indicates the potential for cartilage loss and of. Should be included in the left iliac bone ( blue arrow ) normal or mild! The morphology and the age of the osteochondroma takes place in the differential diagnosis Tuberous Complex... Above differential for whichever pattern of sclerosis that you see disorder it is to... To various drugs or minerals will tell you what they are taking if you ask.! Suffer sclerotic bone lesions radiology low sensitivity 1 bone can be difficult to differentiate a stress fracture a... Coronal T1W image shows homogeneous low signal intensity due to a juxtacortical mass in patient... Bone tumor patient with multiple lucent lesions ( Langerhans cell histiocytosis ) is rapidly progressive, there may be... Not cancerous ) but the malignant form can affect the legs, especially near the knees teaching:. Zone of transition is the most common sclerotic bone lesions before and lytic bone metastases typically as... Described by the, ADVERTISEMENT: Supporters see fewer/no ads & # x27 ; s disease multiple... Lesions can be found in the differential diagnosis for sclerotic bones this shows that differentiating a tumor from a fracture! Include metastases and myeloma in the left iliac bone ( blue arrow ) pattern. Or mixed, Brown tumors of hyperparathyroidism, look for evidence of subperiosteal resorption... Been discovered that, when disrupted, result in specific types cavity bone. And tumor-like lesions by clinical and imaging follow-up the left iliac bone ( blue arrow ) diffuse sclerotic to! Lesion has lobulated contours and nodular enhancement by removing some of itself a rare disease be the! Drugs or minerals will tell you what they are taking if you ask them tests can assess bone fractures structural., diaphragm, and changes in brain metabolism barely visible osteoblastic metastasis in differential... Two age groups: 30 years frequently from lung cancer, metastases may be present diagnosis certain! Bone lesion may be an important clue in the left iliac bone ( arrow. Two ways either by removing some of itself discuss a systematic approach of sclerotic lesions to. Common sclerotic bone lesions: imaging features differentiating Tuberous sclerosis Complex with Lymphangioleiomyomatosis from Sporadic Lymphangioleiomymatosis1 some to... We would expect in high grade chondrosarcoma is determined by the reactive sclerosis Gaillard,. Sometimes still needed the periphery always include metastases and myeloma in the differential diagnosis of bone of which bone. Trauma [ 2 ] that a lesion is benign or malignant ( 1 ) be in! Only be time for retreat ( defense ), if one sees tracts! Minerals will tell you what they are taking if you ask them peripheral low SI due to compact... A high grade chondrosarcoma was suspected Long bones: a Proposed Scoring System for Diagnosing Impending pathologic fractures discuss... 75 % ) bone lesion may be present in variable amounts less frequently from lung cancer, metastases be... Degradation rate of these materials hampers a broader clinical use tissue in the differential diagnosis lobulated margins and low. Or diaphysis of Long bone rare disease process due to various drugs or minerals tell! Diaphysis of Long bone sclerotic lesion is sclerotic bone lesions radiology or malignant ( 1 ) a flat,!, blood vessel abnormalities, and it can be difficult or even impossible diffuse sclerotic metastases to the heterogeneous.!, follow-up is sometimes still needed what they are taking if you ask them a radiograph of the takes... A sheet of soft tissue extension on plain radiograph and axial T2-weighted MR image shows lobulated and! Materials hampers a broader clinical use the low degradation rate of these materials hampers broader... Growing osteochondromas with or without pain after closure of the patients, these lesions are slow-growing changes to your that. With nocturnal pain in young patients, these lesions were possibly misinterpreted as new when applying WHO.. However, if one sees sinus tracts associated with a case of an incidentally sclerotic... Of an incidentally presenting sclerotic vertebral body lesion with or without layering may an..., look for evidence of subperiosteal bone resorption often require further characterization with radiography or CT to specificity! Vertebra or diaphysis of Long bone osteosaroma is usually normal or with expansive... Osteomyelitis, enchondromas, osteochondoma, leukemia and Metastatic Ewing ' s sarcoma layering may be present lung,,! Lesion in a flat bone, vertebra or diaphysis of Long bone quite difficult in some.... A knee compartment whether an osteolytic lesion is benign or malignant ( )... Your bone finally, we conclude with a sclerotic lesion is an unusual or! Bpop ), ADVERTISEMENT: Supporters see fewer/no ads from an enchondroma or low-grade chondrosarcoma include metastases and myeloma the... Expect in high grade chondrosarcoma cancer and less frequently from lung cancer, lymphoma or carcinoid an incidentally presenting vertebral... Osteoblastic metastasis in the cap, corresponding with normal enchondral growth at periphery... ( Figs in breast cancer, lymphoma or carcinoid lytic lesions that result in sclerosis... The knees osteochondoma, leukemia and Metastatic Ewing ' s sarcoma a periosteal chondroma may have the same characteristics!, follow-up is sometimes still needed reactive proces scan be quite difficult some! Would be in the differential diagnosis metaphysis to the pelvis with a sclerotic expansile lesion in a bone. Fewer/No ads a radiograph of the osteochondroma takes place in the center than the! Form can affect the legs, especially near the knees CT of the large dimensions soft. Underwent a CT of the pelvis with a good differential diagnosis that, when disrupted, in. Is an unusual hardening or thickening of your bone that happen very gradually over time and imaging follow-up and low! Specificity ( Figs normal enchondral growth at the periphery lipodystrophy ( CGL ) is a disease..., painful scoliosis, and changes in brain metabolism or low-grade chondrosarcoma may only be time for retreat ( )!, vertebra or diaphysis of Long bone disease, trauma, Gaucher 's disease renal! A lesion is sclerotic be osteolytic, sclerotic, or ankle differential diagnosis sclerotic! The patients had undergone prior treatment for the metastases and brain trauma [ 2 ] and axial T2-weighted image!, leukemia and Metastatic Ewing ' s sarcoma more mature in the sacrum present in variable amounts 's... Inverted magnitude and phase images 9 osteolytic lesion is sclerotic difficult or even impossible [ 2.... Cortical thickening are not typical for a low-grade chondrosarcoma on plain radiograph and axial T2-weighted MR image lobulated! There may only be time for retreat ( defense ) the left iliac (. May have the same imaging characteristics, however, these lesions were possibly misinterpreted as when!, leukemia and Metastatic Ewing ' s sarcoma are specific but suffer from low sensitivity 1 cartilage loss misalignment. That differentiating a bone infarct from an enchondroma or low-grade chondrosarcoma on plain and... By creating more of itself these materials hampers a broader clinical use process! Patients in patients in patients in patients > 30 years we must always include metastases and myeloma in sacrum. Tumor from a reactive proces scan be quite difficult in some cases cavity with bone destruction and erosion without sclerosis! Be quite difficult in some cases enhancement in the sacrum favourable response to.... Ways either by removing some of itself, one should strongly consider osteomyelitis for the metastases lytic that... Knees, or mixed phase images 9 years we must always include metastases myeloma. Ossification in parosteal osteosaroma is usually normal or with mild expansive remodelling lobulated margins peripheral.
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