Mixed density bone lesion

Last revised by Dr Joachim Feger on 23 Jul 2022

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.

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:

  • 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

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