The term mixed density bone lesion is used to describe 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 1.
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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 lytic and sclerotic bone metastases
- multiple myeloma (very rare) 3
- intralesional fat
- intraosseous lipoma
- intraossoeous haemagioma
- Paget disease of bone
- bone infarct
- fibrous dysplasia
- non-ossifying fibroma
- ground glass attenuation 4
- cartilaginous matrix
- enchondroma
- chondrosarcoma
- clear cell chondrosarcoma (usually more lucent)
- chondroblastoma (usually more lucent)
- 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 sclerotic bone lesion with a lucent center
- low T1 bone lesion