Mixed density bone lesion
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- updated 8 May 2022:
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TheThe term mixed density bone lesionis used to describelesions with a combination of osteolytic and osteosclerotic components within or adjacent to cancellous bone. The amount of osteolytic and osteoblastic areas within the lesion remains more or less subjective 1.
Differential diagnosis
Similar to sclerotic bone lesions the differential diagnosis of mixed density bone lesions can be narrowed down according to the following factors 1-3:
- aggressive features
- history of malignancy
- intralesional fatty components (mean density -120 to -30HU or macroscopic fat)
- ground glass attenuation
- cartilaginous matrix (rings and arcs appearance)
- typically benign entities
With regard to the above factors the differential diagnosis includes the following lesions 1-4:
- presence of aggressive features
- history of malignancy
mixed - intralesional fat
intraossoeous- intraosseous lipoma
intraossoeous -
intraossoeous haemagioma
Paget - Paget disease of bone
bone - bone infarct
fibrous - fibrous dysplasia
non - non-ossifying fibroma
- intraosseous lipoma
- ground glass attenuation 4
fibrous - cartilaginous matrix
enchondromachondrosarcomaclear- enchondroma
- chondrosarcoma
-
clear cell chondrosarcoma (usually more lucent)
chondroblastoma -
chondroblastoma (usually more lucent)
typically
- typical benign entities
Practical points
- aggressive features → might require an oncological referral and/or biopsy 1
- history of malignancy → will almost always require additional imaging, follow-up or oncologic referral
- intralesional fatty components in the absence of aggressive features and a history of malignancy → almost always indicate a benign entity
See also
- solitary sclerotic bone lesion
- solitary lucent bone lesion
- solitary
lucentsclerotic bone lesion with a lucent centre - low T1
solitarybone lesion
-<p><strong>The term </strong><strong>mixed density bone lesion</strong><strong> is used to describe </strong>lesions with a combination of osteolytic and osteosclerotic components within or adjacent to cancellous bone. The amount of osteolytic and osteoblastic areas within the lesion remains more or less subjective <sup>1</sup>.</p><h4>Differential diagnosis</h4><p>Similar to sclerotic bone lesions the differential diagnosis of mixed density <strong>bone</strong> lesions can be narrowed down according to the following factors <sup>1-3</sup>:</p><p> </p><p>aggressive features</p><p>history of malignancy</p><p>intralesional fatty components (mean density -120 to -30HU or macroscopic fat)</p><p>ground glass attenuation</p><p>cartilaginous matrix (rings and arcs appearance)</p><p>typically benign entities</p><p> </p><p>With regard to the above factors the differential diagnosis includes the following lesions <sup>1-4</sup>:</p><p>presence of aggressive features</p><p>mixed lytic and sclerotic bone metastases</p><p>chondrosarcoma</p><p>osteosarcoma</p><p>infection: osteomyelitis <sup>2</sup></p><p>eosinophilic granuloma</p><p>history of malignancy</p><p> mixed lytic and sclerotic bone metastases</p><p> myeloma (very rare) <sup>3</sup></p><p>intralesional fat</p><p> intraossoeous lipoma</p><p> intraossoeous haemagioma</p><p> Paget disease of bone</p><p> bone infarct</p><p> fibrous dysplasia</p><p> non-ossifying fibroma</p><p>ground glass attenuation <sup>4</sup></p><p> fibrous dysplasia</p><p>cartilaginous matrix</p><p> enchondroma</p><p> chondrosarcoma</p><p> clear cell chondrosarcoma (usually more lucent)</p><p> chondroblastoma (usually more lucent)</p><p>typically benign entities</p><p>non-ossifying fibroma</p><p>bone infarct</p><h4>Practical points</h4><p>aggressive features → might require oncological referral and/or biopsy <sup>1</sup></p><p>history of malignancy → will almost always require additional imaging, follow-up or oncologic referral</p><p>intralesional fatty components in the absence of aggressive features and a history of malignancy → almost always indicate a benign entity</p><h4>See also</h4><p>solitary sclerotic bone lesion</p><p>solitary lucent bone lesion</p><p>solitary lucent bone lesion with a lucent centre</p><p>low T1 solitary bone lesion</p>- +<p>The<strong> term </strong><strong>mixed density bone lesion</strong><strong> </strong>is used to describe<strong> </strong>lesions with a combination of osteolytic and osteosclerotic components within or adjacent to <a href="/articles/cancellous-bone">cancellous bone</a>. The amount of osteolytic and osteoblastic areas within the lesion remains more or less subjective <sup>1</sup>.</p><h4>Differential diagnosis</h4><p>Similar to sclerotic bone lesions the differential diagnosis of mixed density bone lesions can be narrowed down according to the following factors <sup>1-3</sup>:</p><ul>
- +<li>aggressive features</li>
- +<li>history of malignancy</li>
- +<li>intralesional fatty components (mean density -120 to -30HU or macroscopic fat)</li>
- +<li>ground glass attenuation</li>
- +<li>cartilaginous matrix (rings and arcs appearance)</li>
- +<li>typically benign entities</li>
- +</ul><p>With regard to the above factors the differential diagnosis includes the following lesions <sup>1-4</sup>:</p><ul>
- +<li>presence of aggressive features<ul>
- +<li><a href="/articles/mixed-lytic-and-sclerotic-bone-metastases">mixed lytic and sclerotic bone metastases</a></li>
- +<li><a href="/articles/chondrosarcoma">chondrosarcoma</a></li>
- +<li><a href="/articles/osteosarcoma">osteosarcoma</a></li>
- +<li>infection: <a href="/articles/osteomyelitis">osteomyelitis</a> <sup>2</sup>
- +</li>
- +<li><a href="/articles/langerhans-cell-histiocytosis-skeletal-manifestations-1">eosinophilic granuloma</a></li>
- +</ul>
- +</li>
- +<li>history of malignancy<ul>
- +<li><a href="/articles/mixed-lytic-and-sclerotic-bone-metastases">mixed lytic and sclerotic bone metastases</a></li>
- +<li>
- +<a href="/articles/multiple-myeloma-1">multiple myeloma</a> (very rare) <sup>3</sup>
- +</li>
- +</ul>
- +</li>
- +<li>intralesional fat<ul>
- +<li><a href="/articles/intraosseous-lipoma">intraosseous lipoma</a></li>
- +<li>intraossoeous haemagioma</li>
- +<li><a href="/articles/paget-disease-bone">Paget disease of bone</a></li>
- +<li><a href="/articles/bone-infarction-1">bone infarct</a></li>
- +<li><a href="/articles/fibrous-dysplasia">fibrous dysplasia</a></li>
- +<li><a href="/articles/non-ossifying-fibroma-1">non-ossifying fibroma</a></li>
- +</ul>
- +</li>
- +<li>ground glass attenuation <sup>4</sup><ul><li><a href="/articles/fibrous-dysplasia">fibrous dysplasia</a></li></ul>
- +</li>
- +<li>cartilaginous matrix<ul>
- +<li><a href="/articles/enchondroma">enchondroma</a></li>
- +<li><a href="/articles/chondrosarcoma">chondrosarcoma</a></li>
- +<li>
- +<a href="/articles/clear-cell-chondrosarcoma">clear cell chondrosarcoma</a> (usually more lucent)</li>
- +<li>
- +<a href="/articles/chondroblastoma">chondroblastoma</a> (usually more lucent)</li>
- +</ul>
- +</li>
- +<li>typical benign entities<ul>
- +<li><a href="/articles/non-ossifying-fibroma-1">non-ossifying fibroma</a></li>
- +<li><a href="/articles/bone-infarction-1">bone infarction</a></li>
- +</ul>
- +</li>
- +</ul><h4>Practical points</h4><ul>
- +<li>aggressive features → might require an oncological referral and/or biopsy <sup>1</sup>
- +</li>
- +<li>history of malignancy → will almost always require additional imaging, follow-up or oncologic referral</li>
- +<li>intralesional fatty components in the absence of aggressive features and a history of malignancy → almost always indicate a benign entity</li>
- +</ul><h4>See also</h4><ul>
- +<li><a href="/articles/solitary-sclerotic-bone-lesion">solitary sclerotic bone lesion</a></li>
- +<li>solitary lucent bone lesion</li>
- +<li><a href="/articles/solitary-sclerotic-bone-lesion-with-a-lucent-centre">solitary sclerotic bone lesion with a lucent centre</a></li>
- +<li><a href="/articles/low-t1-bone-lesion">low T1 bone lesion</a></li>
- +</ul>
References changed:
- 1. Chang C, Garner H, Ahlawat S et al. Society of Skeletal Radiology– White Paper. Guidelines for the Diagnostic Management of Incidental Solitary Bone Lesions on CT and MRI in Adults: Bone Reporting and Data System (Bone-RADS). Skeletal Radiol. 2022;:1-22. <a href="https://doi.org/10.1007/s00256-022-04022-8">doi:10.1007/s00256-022-04022-8</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/35344076">Pubmed</a>
- 2. Borjian A, Rezaei F, Eshaghi M, Shemshaki H. Xanthogranulomatous Osteomyelitis. J Orthop Traumatol. 2012;13(4):217-20. <a href="https://doi.org/10.1007/s10195-011-0165-8">doi:10.1007/s10195-011-0165-8</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/22075672">Pubmed</a>
- 3. Ram R & Kumar V. Osteosclerotic & Osteolytic Lesions in Multiple Myeloma. Indian J Med Res. 2014;140(3):441-2. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4248394">PMC4248394</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/25366215">Pubmed</a>
- 4. Fitzpatrick K, Taljanovic M, Speer D et al. Imaging Findings of Fibrous Dysplasia with Histopathologic and Intraoperative Correlation. AJR Am J Roentgenol. 2004;182(6):1389-98. <a href="https://doi.org/10.2214/ajr.182.6.1821389">doi:10.2214/ajr.182.6.1821389</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/15149980">Pubmed</a>
Tags changed:
- bone lesions
Systems changed:
- Musculoskeletal
- Oncology
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