Spiculated periosteal reaction

Last revised by Leonardo Lustosa on 08 Feb 2022

Spiculated periosteal reaction represents spicules of new bone-forming along vascular channels and the fibrous bands that anchor tendons to bone (Sharpey fibers).

A spiculated periosteal reaction signifies a rapid underlying process that prevents the formation of new bone under the raised periosteum.

The orientation of the spicules reflects the direction of tumor growth. Spiculated periosteal reactions can be divided into subtypes based on the orientation of the spicules:

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Cases and figures

  • Figure 1: types of periosteal reactions
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  • Figure 2: perpendicular spiculae (hair-on-end)
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  • Figure 3: divergent spiculae (sunburst)
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  • Case 1: perpendicular spiculae (blue arrows)
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  • Case 2: divergent spiculae (sunburst)
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  • Case 3: skull vault hemangioma
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