J Korean Soc Radiol.  2014 Jul;71(1):39-48. 10.3348/jksr.2014.71.1.39.

Systematic Approach of Sclerotic Bone Lesions Basis on Imaging Findings

Affiliations
  • 1Department of Radiology, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Korea.
  • 2Department of Radiology, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea. lis@pusan.ac.kr
  • 3Department of Radiology, Yeungnam University Hospital, Daegu, Korea.
  • 4Department of Radiology, Kyungpook National University Hospital, Daegu, Korea.
  • 5Department of Radiology, Keimyung University Dongsan Medical Center, Keimyung University College of Medicine, Daegu, Korea.
  • 6Department of Radiology, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea.
  • 7Department of Radiology, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea.

Abstract

Sclerotic bone lesions are common, but there are diverse groups of tumors and non-tumorous lesions. Although plain radiograph and computed tomography can reveal important characteristics of these lesions, diagnosis is often challenging for radiologists. A systematic approach and familiarity with the imaging features of various sclerotic bone lesions may be greatly helpful for eliminating in the differential diagnosis. This review describes the systematic approach to diagnosing sclerotic bone lesions based on imaging findings.


MeSH Terms

Diagnosis
Diagnosis, Differential
Recognition (Psychology)
Sclerosis

Figure

  • Fig. 1 Flow chart of sclerotic bone lesions. Note.-BPOP = Bizzare periosteal osteochondral proliferation, FD = fibrous dysplasia, He = heterogeneous, Ho = homogeneous, LSMF = Liposclerosing myxofibrous tumor, N = non-tumorous condition, OM = osteomyelitis, OSA = osteosarcoma, POEMS = polyneuropathy, organomegaly, endocrinopathy, M protein, and skin changes, SAPHO = synovitis, acne, pustulosis, hyperostosis, osteitis, T = tumorous condition

  • Fig. 2 Sarcoidosis involving the spine. Abdomen CT image showing multifocal osteoblastic nodules in a vertebral body.

  • Fig. 3 POEMS syndrome with a 9-year history of diabetes, peripheral neuropathy, tightness of skin on both hands, pedal edema, increased hair growth, and skin darkening for 3 years. Coronally reformatted spine CT image revealing multiple punctuate osteoblastic lesions. Note.-POEMS = polyneuropathy, organomegaly, endocrinopathy, M protein, and skin changes

  • Fig. 4 Systemic mastocytosis involving pelvic bones. CT scan of pelvis showing multiple osteoblastic lesions at iliac and sacral bones.

  • Fig. 5 Osteoblastic metastasis from prostatic cancer. Plain radiograph showing diffuse, ill-defined sclerotic lesions through the spine, pelvic bones and both femurs.

  • Fig. 6 Fibrous dysplasia. A, B. Polyostoic fibrous dysplasia involving pelvic bones. Plain radiograph (A) and axial CT scan of pelvis (B) reveal ground glass appearance accompanied by bony expansion involving both ilii, left pubis, and ischium. C. Cortical fibrous dysplasia of the tibia. Plain radiograph of the lower leg demonstrating a ill-defined, intracortically sclerotic lesion (arrows) in tibial diaphysis.

  • Fig. 7 Liposclerosing myxofibrous tumor of the femur. A. Plain radiograph showing an ill-defined, mixed sclerotic and lytic lesion with a geographic pattern (arrows) in the intramedullary portion of the right femoral neck. B. Corresponding coronal T1-weighted MR image showing a mixed signal intensity lesion including dark (sclerotic, arrowheads), low (myxoid, asterisk) and focal high (fat, arrow) signals.

  • Fig. 8 Single osteoblastic metastasis from pulmonary adenocarcinoma. Plain radiograph showing eccentrically locating, densly sclerotic lesion (arrows) in the proximal tibia. Imaging finding were non-specific.

  • Fig. 9 Enostosis (bone island) of the humeral head. This homogeneously sclerotic lesion with an irregular, spiculated margin (arrows) was incidentally noted in the humeral head on a plain radiogragh. The lesion margin has been described to resemble "thorny radiations" or a "brush border".

  • Fig. 10 Osteoma arising from the occipital bone. Axial CT scan shows sharply-defined dense, ivory-like sclerotic mass (arrows) with exophytic growing pattern abutting the occipital cortex.

  • Fig. 11 Melorheostosis of foot bones. Plain radiograph of the foot showing flowing cortical and endosteal hyperostosis (arrows) through the third metatarsal and lateral cuneiform bones.

  • Fig. 12 Osteopetrosis of the entire skeleton. Plain radiograph showing densely sclerotic bones lacking differentiation between the cortex and medullary cavity in the entire skeleton.

  • Fig. 13 Osteochondroma of the femur. Plain radiograph showing sclerotic lesion (arrows) composed of cortical and medullary bone protruding from and continuous with the lesser trochanter of femur.

  • Fig. 14 Osteoid osteoma. A. Osteoid osteoma of the humerus. Plain radiograph of right humerus shows an dense sclerotic focus with a thin radiolucent rim, representing nidus (arrows) and surrounding cortical thickening involving the medial cortex of the diaphysis. B, C. Osteoid osteoma of the femur. Plain radiograph showing only circumferentially cortical thickening (arrows) in the proximal diaphysis of femur (B). Corresponding axial CT scan showing a tiny, hypodense nidus (arrow) within the posterior cortex (C).

  • Fig. 15 Osteitis condensans ilii of the iliac side of sacroiliac joints. Plain radiograph of the pelvis shows sclerosis of the ilial portion of the sacroiliac joint, which remained intact.

  • Fig. 16 Osteonecrosis of the femur. Plain radiograph revealing irregular intramedullary sclerosis (arrows) in the distal femur.

  • Fig. 17 Ossifying fibroma of the fibula. Plain radiograph of the lower leg showing a large, ill-defined sclerotic lesion with marked cortical expansion (arrows) in the fibular diaphysis.

  • Fig. 18 Adamantinoma of the tibia. Lateral plain radiograph of the lower leg showing an irregular sclerotic lesion (arrows) within the anterior cortex of tibial diaphysis.

  • Fig. 19 Intramedullary osteosarcoma of the femur. A. Plain radiograph revealing an ill-defined sclerotic lesion with aggressive periosteal reaction in the distal metadiaphysis of the femur. B. Parosteal osteosarcoma of the distal femur. Plain radiograph of the knee showing an ossified exophytic tumor (arrows) on the surface of the femur. Osteolytic intramedullary extension was observed (arrowheads).

  • Fig. 20 Hodgkin's lymphoma of the femur. A. Plain radiograph of the femur showing diffuse cortical thickening. B. Diffuse marrow signal change of high signal intensity through the head, neck and diaphysis of right femur was observed on coronal T2-weighted fat-suppressed MR image (repetition time 2600 msec , echo time 100 msec).

  • Fig. 21 SAPHO syndrome. A. Plain radiograph showing osteosclerosis and hypertrophy (arrows) in the medial portion of the clavicle. B. Whole body bone scan shows increased uptake in sternoclavicular regions (white arrows), a small right axillary lymph node (black dotted arrow) after tracer leakage in the ipsilateral hand. Note.-SAPHO = synovitis, acne, pustulosis, hyperostosis, osteitis

  • Fig. 22 Mixed phase of Paget disease of the pelvis. Anteroposterior plain radiograph showing extensive involvement with areas of cortical (iliopectineal, ilioischial lines, and cortex of the right femoral, arrows) and trabecular (arrowheads) thickening throughout the pelvis. Coxa varus deformity was noted in the right hip.


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