Periosteal reaction recognition and specificity assessed by surface microscopy

Abstract

AbstractPurpose/Research QuestionDistinguishing bone surface alterations from normal longitudinal striations and its semantic characterization are challenging. One classification divides periosteal reaction into woven (interpreted as active disease) and sclerotic (indicative of healing). Another classification “scored” healing if the plaque had rounded edges, seemingly ignoring non‐applicée alterations.Population prevalence and skeletal distribution of periosteal reaction has documented diagnostic significance, in contrast to isolated lesions. Specificity of different forms of periosteal reaction for specific diseases has been controversial.Materials and MethodsSurface microscopy was performed on tibia of healthy individuals and those with in vivo diagnoses of trauma, infection, and metabolic and hypertrophic osteoarthropathy. Triceratops scapula, Mammut metapodial, and Zalophus vertebrae were examined to assess trans‐phylogenetic reproducibility of findings.ResultsPeriosteal reaction was present in 216 individuals with hypertrophic osteoarthropathy with tuberculosis, 84 with nontubercular pulmonary disease, 15 with cancer, and three with endocarditis, 49 with syphilis, 51 with chronic renal insufficiency, 171 with infection, and 621 with fractures. A longitudinal pattern of ridges was observed trans‐phylogenetically in individuals lacking macroscopically perceived cortical alteration. Periosteal reaction predominantly took two forms, an “appliquée” form and an “integrated surface” form. The former appeared as if new bone had been physically pasted on the original surface, whereas the latter appeared to be an integral part of the surface. Both appearances were distinct from normal bone's linear pattern. Both forms were observed in hypertrophic osteoarthropathy (independent of cause), syphilis, trauma, and chronic renal insufficiency. Subperiosteal reaction, in the form of surface erosions often accompanied the periosteal reaction in the presence of chronic renal insufficiency. Filigree reaction was unique to individuals with direct osseous infection.ConclusionsThe character of the periosteal reaction is clearly distinguishable from normal bone but is otherwise nonspecific, with the exception of distinguishing direct pyogenic bone infection and those not directly related to infection and perhaps allowing identification of renal disease.