Mixed lytic and sclerotic bone metastases

Last revised by Dr Joachim Feger on 19 Jul 2022

Mixed lytic and sclerotic bone (osteolytic and osteoblastic) metastases refer to metastatic bone disease with both sclerotic and lytic bone metastases or bone metastases with both components.

The diagnosis is established by proof of sclerotic and lytic bone metastases of one primary tumor or both components in the same distant tumor deposit.

Mixed lytic and sclerotic bone metastases are characterized by the presence of both components, that is areas of bone destruction and areas of increased bone formation within one metastatic tumor deposit or one primary tumor that features both kinds of bone metastases, namely osteolytic and osteoblastic metastases 1.

Mixed lytic and sclerotic bone metastases are seen in several primary malignancies including 1-3:

Imaging characteristics of mixed lytic and sclerotic bone metastases consist of a mixture of both which means the presence of radiodense and lytic areas within one metastasis or the presence of radiodense and radiolucent areas.

Appearances will be that of a mixed density bone lesion or the coexistence of sclerotic and lucent bone lesions 5.

  • T1: low signal
  • T2: variable to hyperintense
  • DWI: diffusion restriction

The radiological report should include a description of the following 2:

  • presence of lytic and sclerotic components or metastases
  • location and size including the whole extent of disease load
  • aggressive features

See article: bone metastases

ADVERTISEMENT: Supporters see fewer/no ads

Cases and figures

  • Case 1: from breast carcinoma
    Drag here to reorder.
  • Case 2: from small cell lung cancer
    Drag here to reorder.
  • Case 3: lobular breast cancer metastasis
    Drag here to reorder.
  • Updating… Please wait.

     Unable to process the form. Check for errors and try again.

     Thank you for updating your details.