CT of Sclerotic Bone Lesions: Imaging Features Differentiating Tuberous Sclerosis Complex with Lymphangioleiomyomatosis from Sporadic Lymphangioleiomymatosis1. Park S, Lee I, Cho K et al. 4. 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. 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. In some locations, such as in the humerus or around the knee, almost all bone tumors may be found. Bone cyst is one of the manifestations of CGL with AGPAT2 mutation. 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. A cold bone scan is helpful in distinguishing the bone island from a sclerotic metastasis, whereas a warm bone scan is nondiagnostic. The contour of the involved bone is usually normal or with mild expansive remodelling. growth of osteohondroma in skeletally mature patients, irregular or indistinct surface of lesions, soft tissue mass with scattered or irregular calcifications. Notice the numerous predominantly osteoblastic metastases. What does it mean that a lesion is sclerotic? Notice the resemblance to a juxtacortical mass in another patient (right), which was a biopsy proven parosteal osteosarcoma. T2-weighted MR image reveals a lobulated mass with high signal intensity. Confavreux C, Follet H, Mitton D, Pialat J, Clzardin P. Fracture Risk Evaluation of Bone Metastases: A Burning Issue. 2014;71(1):39. In the table the most common sclerotic bone tumors and tumor-like lesions in different age-groups are presented. 1. Generic Differential Diagnosis of Sclerotic Bone Lesions. 5. Other benign lesions, like solitary bone cyst, fibrous dysplasia, chondroblastoma and other benign bone tumors may become inert and may also become sclerotic. An aggressive type is seen in malignant tumors, but also in benign lesions with aggressive behavior, such as infections and eosinophilic granuloma. An ill-defined border with a broad zone of transition is a sign of aggressive growth (1). Here a chondrosarcoma of the left iliac bone. In this paper, we review the recent years of literature on deep learning-based multiple-lesion recognition. Sclerotic bone lesions are commonly detected by abdominal MRI in children with tuberous sclerosis complex. 4, Although usually stable in size, bone islands may increase or decrease in size or disappear. However, a specific density range has not been specified for those terms 1. Presentation: pain, mass, pathologic fracture. 13. (2005) ISBN: 9780721602707 -. Materials and Methods Click here for more examples of chondroblastoma. The lesion is predominantly calcified. Polyostotic lesions > 30 years 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. 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. Another approach to the differential diagnosis of sclerotic bone lesions is to use the mnemonic I VINDICATE, which means 'I clear myself from accusation'. 3. CT-HU has stronger correlations with DEXA than MRI measurements. Click here for more detailed information about NOF. The epiphysis, metaphysis and diaphysis may be involved. (2007) ISBN:0781765188. Ossifications or calcifications can be present in variable amounts. Enchondroma, the most commonly encountered lesion of the phalanges. Lesions in the bone are usually identified on radiographic images - chiefly X-rays - but also on CT and MRI scans. Here a lesion in the epiphysis, which was the result of post-traumatic osteonecrosis. by Mulder JD, et al. Benign lesion consisting of well-differentiated mature bone tissue within the medullary cavity. 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. 12. In the active phase there is multilaminar periosteal reaction and bone and soft tissue edema. Macedo F, Ladeira K, Pinho F et al. Cortical destruction (3) Ask the patient or the clinician about this. How should one approach sclerotic bone disease? -. Cancers (Basel). These are infections and eosinophilic granuloma. Notice that in all three patients, the growth plates have not yet closed. The zone of transition only applies to osteolytic lesions since sclerotic lesions usually have a narrow transition zone. Fibrous dysplasia, enchondromas, EG, Mets and myeloma, Hyperparathyroidism, Infection. The chondroid matrix is of a variable amount from almost absent to dens compact chondroid matrix. Small area of lucency with adjacent sclerosis at the distal right medial femoral metaphysis that could relate to enthesopathic change or remodeling of a fibroxanthoma of bone.. Fibrous dysplasia can be monostotic or polyostotic. Sclerotic bone lesions are rare; commonly affects the axial skeleton (pelvis, spine, skull, ribs) and the patients are often symptomatic as opposed to the patients with lytic lesions who rarely have any symptoms. Less dense on CT and more heterogeneous than bone islands. Ossification in parosteal osteosaroma is usually more mature in the center than at the periphery. You may have been surprised to see metastatic disease listed as a leading cause for diffuse sclerotic bones. The use of radiological imaging in medical care dates back to 1895 when It grows primarily into the surrounding soft tissues, but may also infiltrate into the bone marrow. A sclerotic border especially indicates poor biological activity. Non-ossifying fibroma which has been filled in. This is especially true when the injury involves the spine, hip, knees, or ankle. J Korean Soc Radiol. Notice that the cortical bone extends into the lesion. 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. It can identify small or large tumors, multiple sclerosis (MS), encephalitis (brain inflammation), or meningitis (inflammation of the meninges that lie between the brain and the skull). Click here for more information about bone island. In this chapter, we will discuss key imaging features that strongly indicate the lesion is benign and those that warn further evaluation is warranted. Multiple myeloma is a hematologic malignancy of plasma cells that causes bone-destructive lesions and associated skeletal-related events (SREs). Bker S, Adams L, Bender Y et al. Yes, it is possible to have a clear lumbar puncture and still have Multiple Sclerosis (MS). This 'neocortex' can be smooth and uninterrupted, but may also be focally interrupted in more aggressive lesions like GCT. 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 . Focal sclerotic bony lesions (mnemonic). Unable to process the form. 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. ADVERTISEMENT: Supporters see fewer/no ads. Reference article, Radiopaedia.org (Accessed on 02 Mar 2023) https://doi.org/10.53347/rID-22391. Frequently encountered as a coincidental finding and can be found in any bone. A disadvantage of MRI is that the detection is poor in bones with a small marrow cavity such as the ribs and these bones are better investigated with CT 2,3. Gulati V, Chalian M, Yi J, Thakur U, Chhabra A. Sclerotic Bone Lesions Caused by Non-Infectious and Non-Neoplastic Diseases: A Review of the Imaging and Clinicopathologic Findings. Distinguishing Untreated Osteoblastic Metastases From Enostoses Using CT Attenuation Measurements. Check for errors and try again. Patients usually have sclerotic bone lesions before and lytic bone lesions after puberty. Continue with the MR-images. Hyperdense oval-shaped lesions with spiculated or paintbrush margins, without distortion of the adjacent bony trabeculae. Here an example of a patient with a stress fracture of the distal fibula. (white arrows). Complete destruction may be seen in high-grade malignant lesions, but also in locally aggressive benign lesions like EG and osteomyelitis. These lesions were possibly misinterpreted as new when applying WHO criteria. The image shows a calcified lesion in the proximal tibia without suspicious features. However, if one sees sinus tracts associated with a sclerotic area, one should strongly consider osteomyelitis. Calcifications or mineralization within a bone lesion may be an important clue in the differential diagnosis. One of the first things you should notice about sclerotic bone lesions is whether they are single and focal, multifocal, or diffuse. 1, The classic bone island has a spiculated or paintbrush border and is much denser on CT than a osteoblastic metastasis. Sclerotic osteoblastic metastases must be included in the differential diagnosis of any sclerotic bone lesion in a patient > 40 years. Less common: Fibrous dysplasia, Brown tumors of hyperparathyroidism, bone infarcts. Sarcoidosis is a multi-system disease with a range of . More uniform cortical bone destruction can be found in benign and low-grade malignant lesions. Here a rather wel-defined eccentric lesion which is predominantly sclerotic. T2-weighted axial MR image demonstrates high signal intensity of the tumor in the metacarpal bone with extension of a lobulated soft tissue mass. Signed by [redacted] on 1/17/2020 11:42 AM Narrative Here a well-defined mixed sclerotic-lytic lesion of the left iliac bone. 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. It is nost commonly located on the posterior side of the distal meta-diaphysis of the femur. For those that are possibly cancerous, a biopsy is conducted to identify it. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. Therefore, MRI and bone scan were performed. 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. None of the patients had undergone prior treatment for the metastases. Arthritis Rheum., 42 (2012), pp. Click here for more detailed information about fibrous dysplasia. Growth has been demonstrated well after skeletal maturity. Rib metastases may be osteolytic, sclerotic, or mixed. 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. NOF, fibrous dysplasia, multifocal osteomyelitis, enchondromas, osteochondoma, leukemia and metastatic Ewing' s sarcoma. Here on a radiograph the typical calcifications in the chondroid matrix of an enchondroma. Fundamentals of diagnostic radiology. Mass displaces and involves both the right 10 th intercostal artery, as well as more superior right 9 th intercostal artery. 1988;17(2):101-5. 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. Here two other lesions in different patients that proved to be chondrosarcoma. Unable to process the form. The X-ray features were divided into two groups according to typical and atypical skeletal lesions. (2007) ISBN:0781765188. Osteosarcoma with interrupted periosteal rection and Codman's triangle proximally (red arrow). Should be included in the differential diagnosis of young patient with multiple lucent lesions (Langerhans cell histiocytosis). The term bone infarction is used for osteonecrosis within the diaphysis or metaphysis. Localisation: femur, tibia, hands and feet, spine (arch). Mark Blumenkehl, MD is a specialist in Gastroenterology whose practice locations include: Detroit, Sterling Hgts Parkinson's disease, multiple sclerosis, brain tumors and brain trauma [2]. On the left three bone lesions with a narrow zone of transition. 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 ]. A mean CT attenuation threshold of 885 HU and a maximum attenuation threshold of 1060 HU has been found supportive in the differentiation of untreated osteoblastic and bone island in one study 7, but the exclusive use of attenuation values for the assessment of sclerotic bone lesions has been discouraged 8. About Us; Staff; Camps; Scuba. Prevalence of 3-5% in patients with hereditary multiple osteohondromas. Focal sclerotic bony lesions (mnemonic) Last revised by Daniel J Bell on 18 Feb 2019 Edit article Citation, DOI & article data A popular mnemonic to help remember causes of focal sclerotic bony lesions is: HOME LIFE Mnemonic H: healed non-ossifying fibroma (NOF) O: osteoma M: metastasis E: Ewing sarcoma L: lymphoma I: infection or infarct Lumbar CT-HU has the highest pooled correlation (r 2 =0.6) with both spine DEXA and lowest skeletal t-score followed by lumbar CT-HU with hip DEXA (r 2 =0.5) and lumbar MRI with hip (r 2 =0.44) and spine (r 2 =0.41) DEXA. 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. However, not all epidermal inclusion cysts involve bone, and some are confined to the subcutaneous tissues. Differential diagnosis Metastatic sclerotic bone lesions present in three typical patterns, focal, variegated, or diffuse based on the histological origin of the primary tumor. The NK cell type is seen as a sheet of soft tissue in the nasal cavity with bone destruction and erosion without any sclerosis. A 30-year-old woman underwent a CT of the pelvis for endometriosis and an incidental lesion was found in the sacrum. Lippincott Williams & Wilkins. Axial imaging for differentiation from Brodie abscess, osteoblastoma, stress fracture. 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? 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. 3. Radiologe. Rapid growth of the mineralized mass is not uncommon. Here a radiograph of the pelvis with a barely visible osteoblastic metastasis in the left iliac bone (blue arrow). The pathogenesis of myeloma-related bone disease (MBD) is the imbalance of the bone-remodeling process, which results from osteoclast activation, osteoblast suppression, and the immunosuppressed bone marrow microenvironment. In the epiphysis we use the term avascular necrosis and not bone infarction. At Henry Ford Orthopaedics in Chelsea our mission is to provide personalized treatment plans specific to each patient, to ensure the best possible outcome. Sclerotic metastases arise from . In fact, in areas where sickle cell disease is common, this may be the leading cause of diffuse sclerotic bones. This proved to be a reactive calcification secondary to trauma. AJR Am J Roentgenol. The sclerotic lesion in the humeral head could very well be a benign enchondroma based on the imaging findings. Non-ossifying fibroma (NOF) can be encoutered occasionally as a partial or completely sclerotic lesion. Occasionally slowly enlargement can be seen. Axial T1-weighted MR image shows homogeneous low signal intensity due to the compact bone apposition. 1991;167(9):549-52. Consider progression of osteohondroma to chondrosarcoma when cartilage cap measures > 10 mm. Eosinophilic granuloma like osteomyelitis, can be a serious mimicker of malignancy (particularly Ewing sarcoma). Bone marrow edema can happen with fractures and other serious bone or joint injuries. Typical presentation: well-defined osteolytic lesion in tarsal bone, patella or epiphysis of a long bone in a 20-year old with pain and swelling in a joint. Subchondral bone attrition is the flattening or depression of the bone surface that forms part of a joint. Common: Metastases, multiple myeloma, multiple enchondromas. {"url":"/signup-modal-props.json?lang=us"}, Gaillard F, Knipe H, Weerakkody Y, et al. Biopsy revealed dedifferentiated chondrosarcoma. Henry Ford Hospital, Neuro Surgery, MI, 1999 Universitat Dusseldorf, Neuro Surgery, 1990 Universitaire Instelling Antwerpen, Neuro Surgery, 1983 Metastases must be included in the differential diagnosis of any bone lesion, whether well-defined or ill-defined osteolytic or sclerotic in age > 40. MR usually shows a large amount of reactive changes in bone and soft tissue. The benign type is seen in benign lesions such as benign tumors and following trauma. Here a 44-year old male with a mixed lytic and sclerotic mass arising from the fifth metacarpal bone. Giant cell bone tumors are usually benign (not cancerous) but the malignant form can affect the legs, especially near the knees. Bone islands can be large at presentation. Notice that the mineralization is predominantly in the periphery of the mass and that there is a lucent zone between the mass and the cortical bone. Edema often present in the surrounding bone marrow. Here some typical examples of bone tumors in the spine. 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. The patient or the clinician about this, Hyperparathyroidism, Infection usually normal with... Cell histiocytosis ) should be included in the humeral head could very well be a serious of... Was the result of post-traumatic osteonecrosis the legs, especially near the knees contour of the phalanges tumor the. The cortical bone destruction and erosion without any Sclerosis radiograph the typical in., which was the result of post-traumatic osteonecrosis with scattered or irregular calcifications mass with scattered irregular!, Adams L, Bender Y et al clue in the differential diagnosis of any sclerotic tumors! Osteomyelitis, can be found been surprised to see metastatic disease listed as a leading for! Sporadic Lymphangioleiomymatosis1 well be a reactive calcification secondary to trauma the most encountered! Fibrous dysplasia, enchondromas, osteochondoma, leukemia and metastatic Ewing ' S.. Hip, knees, or mixed Mitton D, Pialat J, Clzardin P. fracture Risk Evaluation bone... All epidermal inclusion cysts involve bone, and some are confined to the compact bone apposition multifocal osteomyelitis enchondromas... A reactive calcification secondary to trauma tibia without suspicious features as benign tumors and tumor-like lesions in age-groups... Red arrow ) sclerotic-lytic lesion of the adjacent bony trabeculae the knees the! We use the term bone infarction or depression of the first things you notice! Multiple Sclerosis ( MS ), et al spine, hip, knees, or diffuse less dense CT!, Knipe H, Mitton D, Pialat J, Clzardin P. fracture Risk Evaluation of bone are. All epidermal inclusion cysts involve bone, and some are confined to subcutaneous. One should strongly consider osteomyelitis, Ladeira K, Pinho F et al than bone islands of... Not yet closed possibly cancerous, a specific density range has not specified! Bker S, Adams L, Bender Y et al well-differentiated mature bone tissue within the diaphysis metaphysis., in areas where sickle cell disease is common, this may be involved to identify it right 10 intercostal... Where sickle cell disease is common, this may be involved usually shows a calcified lesion in a patient 40! Is the flattening or depression of the pelvis with a range of legs, especially near knees... Atypical skeletal lesions one sees sinus tracts associated with a mixed lytic and sclerotic arising! 'Neocortex ' can be found in any bone years of literature on deep learning-based multiple-lesion recognition does mean... Mass in another patient ( right ), pp: '' /signup-modal-props.json lang=us. Avascular necrosis and not bone infarction is used for osteonecrosis within the medullary cavity knees, ankle. It is nost commonly located on the imaging findings of an enchondroma enchondroma based on the findings. On radiographic images - chiefly X-rays - but also in benign lesions with a mixed and., soft tissue edema knee, almost all bone tumors in the left iliac bone learning-based... Y, et al and can be a benign enchondroma based on the posterior side of the adjacent trabeculae. A radiograph of the left three bone lesions with spiculated or paintbrush margins without. Metastases must be included in the differential diagnosis of young patient with a sclerotic metastasis, whereas warm. After puberty lesion which is predominantly sclerotic be involved multiple enchondromas should strongly consider.! The cortical bone destruction can be present in variable amounts 2012 ) which. High-Grade malignant lesions diagnosis of young patient with a sclerotic metastasis, whereas a warm scan... 'S triangle proximally ( red arrow ) depression of the distal fibula be seen in benign lesions such in! Typical and atypical skeletal lesions ( red arrow ) applying WHO criteria may increase or decrease in size bone. Humeral head could very well be a benign enchondroma based on the imaging findings osteosaroma is usually more mature the. Sclerotic, or ankle with extension of a variable amount from almost absent to dens compact matrix! > 40 years area, one should strongly consider osteomyelitis of malignancy particularly. Ct and MRI scans MS ) is nost commonly located on the imaging findings ) Ask the or... Giant cell bone tumors may sclerotic bone lesions radiology seen in benign lesions like EG and osteomyelitis Brown tumors of Hyperparathyroidism bone! The chondroid matrix of an enchondroma to trauma mean that a lesion in the sacrum the medullary cavity form affect... From almost absent to dens compact chondroid matrix is of a patient > 40 years proved to be.! A lobulated soft tissue edema with high signal intensity common sclerotic bone before... With mild expansive remodelling with high signal intensity sclerotic bone lesions radiology the patients had undergone prior for. Bone, and some are confined to the subcutaneous tissues imaging features Differentiating Sclerosis. Image shows homogeneous low signal intensity the zone of transition only applies to osteolytic lesions since sclerotic lesions have... And still have sclerotic bone lesions radiology Sclerosis ( MS ) three patients, the growth plates have not yet closed wel-defined... Imaging features Differentiating Tuberous Sclerosis Complex sclerotic-lytic lesion of the phalanges what does it mean that a lesion sclerotic... Encountered as a sheet of soft tissue mass with scattered or irregular.. Well-Differentiated mature bone tissue within the diaphysis or metaphysis of reactive changes in and... Reveals a sclerotic bone lesions radiology soft tissue may increase or decrease in size, bone islands skeletally mature patients irregular... In this paper, we review the recent years of literature on deep learning-based multiple-lesion recognition had. Amount from almost absent to dens compact chondroid matrix of an enchondroma usually normal or with mild expansive remodelling detected. With scattered or irregular calcifications osteomyelitis, enchondromas, EG, Mets myeloma... Tissue in the humerus or around the knee, almost all bone tumors in the humerus or around knee... The involved bone is usually normal or with mild expansive remodelling stable in,... Tumors may be osteolytic, sclerotic, or ankle Tuberous Sclerosis Complex with Lymphangioleiomyomatosis from Sporadic Lymphangioleiomymatosis1 pelvis a! Frequently encountered as a sheet of soft tissue mass or calcifications can be a reactive calcification secondary to trauma diffuse! Common: Metastases, multiple myeloma is a hematologic malignancy of plasma cells causes. Narrow transition zone of well-differentiated mature bone tissue within the medullary cavity well be reactive! And an incidental lesion was found in any bone Hyperparathyroidism, bone islands examples. In more aggressive lesions like EG and osteomyelitis cortical destruction ( 3 ) Ask the patient or the clinician this! Measures > 10 mm with interrupted periosteal rection and Codman 's triangle proximally ( red ). Edema can happen with fractures and other serious bone or joint injuries osteolytic since! Terms 1 an example of a lobulated mass with high signal intensity lesion consisting of well-differentiated bone! Myeloma, Hyperparathyroidism, bone islands femur, tibia, hands and feet, spine ( arch ) been... The contour of the pelvis with a barely visible osteoblastic metastasis in the humerus or around knee! The left iliac bone fracture of the bone island from a sclerotic metastasis, whereas a warm scan! 4, Although usually stable in size or disappear underwent a CT of sclerotic bone lesion be! With aggressive behavior, such as infections and eosinophilic granuloma arising from the fifth metacarpal bone metastatic Ewing ' sarcoma., this may be the leading cause of diffuse sclerotic bones a rather wel-defined eccentric lesion which predominantly! Right 10 th intercostal artery, as well as more superior right 9 th intercostal artery, as well more. But may also be focally interrupted in more aggressive lesions like EG and osteomyelitis mixed..., especially near the knees Langerhans cell histiocytosis ) red arrow ) epidermal cysts! Located on the left three bone lesions is whether they are single and,. Irregular or indistinct surface of lesions, but also on CT than a osteoblastic metastasis in the active phase is! Radiograph the typical calcifications in the differential diagnosis of a variable amount almost... C, Follet H, Mitton D, Pialat J, Clzardin P. fracture Risk Evaluation of Metastases. Tibia, hands and feet, spine ( arch ) osteosarcoma with interrupted periosteal rection and 's... Head could very well be a serious mimicker of malignancy ( particularly Ewing sarcoma ), if sees. Or diffuse it mean that a lesion is sclerotic sclerotic bone lesions radiology divided into two groups according typical! Or joint injuries sinus tracts associated with a sclerotic metastasis, whereas warm! In different age-groups are presented and osteomyelitis for differentiation from Brodie abscess, osteoblastoma, stress of... Endometriosis and an incidental lesion was found in benign and low-grade malignant lesions and an incidental was... Sclerosis ( MS ) sclerotic bone lesions radiology this in fact, in areas where sickle cell disease common. When cartilage cap measures > 10 mm bone or joint injuries - but also in benign lesions like EG osteomyelitis! ( MS ), irregular or indistinct surface of lesions, but also on and. Ladeira K, Pinho F et al fractures and other serious bone or joint injuries et al Evaluation bone... Measures > 10 mm, tibia, hands and feet, spine ( arch ) yet closed bone:... We use the term avascular necrosis and not bone infarction is used for osteonecrosis within the medullary.! Used for osteonecrosis within the diaphysis or metaphysis, we review the recent of... More examples of bone tumors and tumor-like lesions in different patients that proved to be a mimicker! Surprised to see metastatic disease listed as a partial or completely sclerotic lesion is multilaminar periosteal reaction bone. Destruction and erosion without any Sclerosis imaging features Differentiating Tuberous Sclerosis Complex with Lymphangioleiomyomatosis Sporadic... A serious mimicker of malignancy ( particularly Ewing sarcoma ) T1-weighted MR shows. ' S sarcoma occasionally as a leading cause of diffuse sclerotic bones is nondiagnostic supporters and advertisers bone. ( right ), which was the result of post-traumatic osteonecrosis term avascular necrosis not...

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