Lucent bone lesions Bone tumors are mostly benign. The most important determinants in imaging of bone tumors are morphology on plain radiograph (well-defined lytic, ill-defined lytic, and sclerotic lesions) and age of the patient at presentation. Well-defined osteolytic bone tumors and tumor-like lesions have many differentials in different age groups. For simplicity, a widely used …
Common features of solitary intraosseous lesions Peak age (years) Location Centrality Density Margin Expansile a Periosteal Reaction b Notes Generally well-defined predominantly lytic lesions Simple bone cyst 5–20 Met±Dia Central Lucent Well+Scl −/+ − Unilocular. ‘Fallen fragment’ if fractured Aneurysmal bone cyst 5–30 Met Eccentric Lucent Well+Scl ++ − Expansile, bubbly . May occur 2° to another lesion Giant cell …
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Skeletal metastases Nearly all malignant tumours can metastasize to bone, but 80% are from prostate, breast, lung or kidney. Mainly involves the axial and proximal appendicular skeleton (red marrow)—distal appendicular bone metastases are rare and usually from lung or, less commonly, breast. Most bone metastases are lytic; sclerotic or mixed metastases have a more limited …
Coarse trabecular pattern 1. Paget’s disease . 2. Osteoporosis . 3. Osteomalacia . 4. Haemoglobinopathies . 5. Haemangioma . 6. Gaucher disease.
Solitary sclerotic bone lesion with a lucent centre Most common 1. Osteoid osteoma/osteoblastoma —lucent nidus. 2. Brodie’s abscess . 3. Medullary bone infarct —irregular serpentine outline. 4. Stress fracture —lucent fracture line may be visible. Less common 5. Looser’s zone of osteomalacia . 6. Liposclerosing myxofibrous tumour —characteristic location in the intertrochanteric region of the femur. 7. Tuberculosis . Rare 8. Syphilis. 9. Yaws.
Causes of Bone sclerosis with a periosteal reaction Most common 1. Healing fracture . 2. Metastasis —osteoblastic metastases from prostate. 3. Osteoid osteoma/osteoblastoma —solid or lamellated periosteal reaction. 4. Chronic osteomyelitis —look for sequestrum. 5. Osteosarcoma —classically sunray spiculation. Less common 6. Ewing sarcoma —often onion-skin or lamellated periosteal reaction. 7. Chondrosarcoma —chondroid matrix with regions of enchondral ossification. 8. Lymphoma . 9. CRMO —clavicles and tibias in children and adolescents. 10. SAPHO syndrome —similar …
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Causes of Multiple sclerotic bone lesions Most common 1. Metastases —prostate, breast, mucinous adenocarcinoma of GI tract, carcinoid, lymphoma, TCC in adults. Medulloblastoma and neuroblastoma in children. 2. Multiple healed bone lesions —lytic metastases following radiotherapy or chemotherapy. Eosinophilic granulomas and brown tumours following treatment. 3. Paget’s disease —often polyostotic. Less common 4. Multiple bone infarcts —consider an underlying disorder, e.g. sickle cell …