Author:
M.Reza Fardanesh
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Radiograph |
CT |
MRI - T1 |
MRI - T2 or STIR |
MRI - Post-contrast T1 |
Radionuclide |
Gross Pathology |
Histology |
Additional comments |
| Osteoid Osteoma |
Image a. round calcified, sharply demarcated nidus w/normal surrounding bone.
Image b. Post enucleation.
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Periosteal rxn, thickening of anteromedial cortex, & low-attenuation nidus (arrow) w/central mineralization. Reactive sclerosis of bone marrow (*) adjacent to nidus.
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low-signal-intensity nidus (arrow)
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nidus w/high signal intensity peripherally & heterogeneous signal intensity centrally. Note Periosteal elevation (arrowheads).
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low-signal nidus w/strong enhancement (periphery of nidus enhances > central portion). Note edema in surrounding bone marrow (*) & soft tissue (arrowheads).
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Nidus (*) extending to facet cartilage (arrows).
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Interconnecting trabeculae, background fibrovascular tissue, & minimal surrounding sclerosis. (original
magnification, x150; hematoxylin-eosin stain).
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| Osteoblastoma |
markedly expansile lesion involving spinous process & laminae (arrows), w/vague sclerosis.
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marked expansion of C3 lesion w/defined sclerotic rim (arrows). Matrix mineralization (arrowheads) can simulate rings & arcs of chondroid tissue.
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Mass (arrows) can encroach on spinal canal (arrowheads).
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extensive mineralization of mass, which has relatively low signal intensity.
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expanded, bohulated mass (*) w/whitish tissue that represents osteoid matrix.
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| Sclerosing Osteomyelitis |
multiple pyramid-shaped lytic lesions w/surrounding
sclerosis in metaphyses of tibia & fibula (straight arrow); lesions extend across growth plate into epiphysis (wavy arrow). Multiple apophyseal lesions also present in tarsal bones (arrowheads). Note generalized osteopenia.
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lytic
areas in right mandibular ramus (arrow)
with sclerosis & bony expansion, w/associated
overlying soft-tissue swelling.
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decreased marrow signal intensity (arrow) & cortical interruption.
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increased marrow signal intensity (arrow).
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enhancement within subcutaneous tissues, consistent w/cellulitis near an ulcer site (arrow).
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Dynamic (left), blood pool (center), & bone (right) images from a three-phase bone scan: focal hyperperfusion, focal hyperemia, & foci of increased bone uptake, respectively, in right great toe.
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fragments of bone surrounded by fibrous stroma, in which there are scattered inflammatory cells & macrophages (original magnification, ×100; H-E stain).
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| Enostosis |
Nonspecific sclerotic focus in anterior portion of L-3 (arrowhead).
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densely sclerotic lesion w/irregular spiculated border just beneath anterior cortex to left of midline (arrowheads).
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cortical bone (arrows) w/irregular margins (arrowheads) (original magnification, xl 50; H-E stain).
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| Bone infarct |
Image a (initial): periosteal new bone formation (arrows), w/normal
bone texture.
Image b (6 weeks later): distortion of bone texture, w/incorporation of region of periosteal rxn into cortical bone & resultant cortical thickening, & linear
serpiginous areas of sclerosis in left tibial shaft.
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Mixed sclerotic & osteolytic lesion, here seen within greater wing of left sphenoid bone (arrow). Note thickening of sphenoid & petrous bones in this example.
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area of slightly heterogeneous signal intensity within left sphenoid bone. No fatty marrow is seen within lesion.
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areas of high signal intensity in left mandibular ramus (arrowhead) & sphenoid bone (arrow).
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mandibular ramus (arrowhead) & sphenoid bone (arrow) lesions demonstrate homogeneous enhancement.
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Medial (left) & lateral (right) views of the
left (L) tibia from late static phase 99mTc MDP scintigraphy
show an area of decreased tracer uptake w/in
proximal shaft (arrowheads).
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| AVN |
Example: AVN of talus
Image 3a&b: marked sclerosis of talar dome (arrow).
Image 4: increased opacity = osteonecrotic segment.
Image 5: lobulated subchondral lucency (black arrows) = necrotic segment outlined by peripheral sclerosis. Depression at articular surface (white arrow) = talar collapse.
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Image 1: mixed hypoattenuating-sclerotic pattern along medial half of talar dome is outlined by serpiginous sclerotic line (arrows). mixed imaging
pattern is consistent w/osteonecrosis.
Image 2: diffuse
sclerosis involving majority of talus (white arrows), w/focal sparing of
lateral talar dome (black arrow)
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serpiginous
low-signal-intensity line in talar dome (arrows).
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high-signal-intensity line in talar dome (arrow) outlines an avascular segment.
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Image c: thinned cartilage stained green by alcian green dye (helps ID mucopolysaccharides). Staining of articular cartilage is less green than expected (white arrow). Curvilinear fibrous tissue band (black arrows) appears as pale pink band outlining area of necrosis.
Image d: Highpower decalcified section shows viable tibia (Ti) & necrotic talus (Ta) on either joint side. Trabeculae on viable side show smooth endosteal contours (white arrows); On necrotic side, subjacent bone contains fragmented trabeculae (black arrows) & patchy eosinophilia (black arrowheads) consistent w/saponification.
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| Enchondroma |
arcs & rings pattern of mineralized chondroid matrix (arrowheads). Endosteal
scalloping (arrows in a) can be seen.
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lobulated lesion (arrowheads)
w/heterogeneous primarily intermediate signal, w/focal areas of low signal from mineralization
(large white arrows) & high signal from entrapment of
residual normal fatty marrow (small arrows). Incidental full thickness rotator cuff tear (black arrow).
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primarily high in signal, w/low-signal
areas again 2nd to mineralization (white arrows). Incidental full thickness rotator cuff tear (black arrow).
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Delayed bone scintigmam:
faint uptake (grade 1 - less than anterior iliac crest) within lesion (arrow).
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lobular growth pattern & white chondroid matrix (*). Focal shallow endosteal scalloping (arrow) correlates well w/imaging appearance.
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chondroid tissue (*) surrounding islands of fatty marrow (arrows).
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| Paget's Disease |
Image a: large area of subchondral lysis w/sharp inferior margin (arrowheads).
Image b: lytic lesion in tibial tubercle w/blade-of-grass appearance superiorly & inferiorly (arrows).
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posterior thickening & mixed lysis & sclerosis (area between arrows).
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diffuse calvarial thickening remains low signal intensity w/both pulse sequences (*).
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diffuse calvarial thickening remains low signal intensity w/both pulse sequences (*).
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Example of sarcomatous transformation of Paget disease to malignant fibrous histiocytoma shows marked enhancement.
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Whole-body scintigram demonstrates increased radiotracer accumulation in proximal right femur & in deformed & enlarged tibias.
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incomplete fractures w/callus (between arrowheads).
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intracortical, nonsubchondral location (*) & sharp superior margin (arrow).
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| Osteoblastic Metastases |
Example: dense osteosclerosis (breast Ca)
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Example: extensive multifocal osteoblastic metastases (prostate Ca).
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Technetium-99m
methylene diphosphonate bone scan demonstrates intense, near-diffuse osseous radiotracer uptake with
minimal renal activity (“superscan”). Example of pt w/prostate Ca.
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| Sickle Cell Anemia |
Diffusely sclerotic bones
& thickened trabeculae d/t medullary infarction & dystrophic calcification. Well-circumscribed
foci of semilunar serpiginous sclerosis in femoral
epiphyses (arrows) consistent w/avascular
necrosis.
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Thickening of skull base, especially in sphenoid & petrous bones. A mixed sclerotic & osteolytic lesion within greater wing of left sphenoid bone (arrow) = prior bone infarction.
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Areas of intermediate signal d/t persistence of appendicular red marrow in the
medullary cavities (arrowhead) make assessment of osteomyelitis difficult. Additionally, soft-tissue infection present in this pt [low-signal-intensity fluid collection within pre-Achilles fat space (arrow)].
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abnormal heterogeneous signal
intensity in L1 & L2 vertebrae compatible w/infarction.
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Example: Bone infarction in sickle cell
Medial (left) & lateral (right) views of left (L) tibia from late static phase 99mTc MDP scintigraphy
show area of decreased tracer uptake within
proximal shaft (arrowheads), suggestive of
infarction.
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extensive
ulceration of lower leg of an adult patient
with sickle cell disease.
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| Progressive diaphyseal dysplasia |
Image 9: right & left forearms show bilateral & symmetric cortical thickening involving both periosteal
and endosteal surfaces. Medullary canals are narrowed & there is characteristic sparing of epiphyses.
Image 10: right & left tibia & fibula
demonstrate symmetric cortical thickening in diaphyses of long bones.
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diffuse osseous sclerosis of skull base.
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T1-
weighted (a) & short inversion
time inversion-recovery (b)
images
show characteristic unilateral
cortical thickening involving
right femur, w/no involvement
of left femur.
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