Osseous Lesions Research Articles

The radiologic and FDG uptake findings of osseous lesions incidentally detected on 18F-FDG-PET/CT imaging.

BackgroundIn routine clinical practice, incidental solitary bone lesions are commonly seen on various imaging modalities. 18F-FDG-positron emission tomography (PET)/computed tomography (CT) imaging provides functional and morphological information in oncology patients, and incidental bone lesions are often detected during the scan.PurposeTo evaluate the metabolic characteristics and CT morphological findings of incidental bone lesions detected in patients undergoing 18F-FDG-PET/CT imaging.Material and MethodsSUVmax values and CT characteristics of incidental osseous lesions reported in 86 patients undergoing 18F-FDG-PET/CT imaging between 2019 and 2023 were evaluated. In addition, the SUVmax values of the lesions were compared with bone areas without adjacent/contralateral density/FDG changes. CT characteristics of incidental osseous lesions were evaluated.ResultsThe study group included 52 women and 34 men (age range = 26-89 years). CT identified typical bone haemangioma lesions in 45/86 (52%) cases. Non-haemangioma lesions were mainly benign bone pathologies: fibrous dysplasia; Paget's disease; perineural cyst; osteonecrosis; and osteoma. The mean SUVmax value of 41 non-haemangioma bone lesions (4.27 ± 3.71) was significantly higher than that in adjacent/contralateral normal density areas (2.31 ± 1.27; P = 0.01).Conclusion18F-FDG-PET/CT imaging shows varying FDG uptake in incidental osseous lesions. Morphological features on CT play a critical role in diagnosis and avoiding unnecessary imaging or interventions.

Diffuse pulmonary ossification and its association with cicatricial organising pneumonia in idiopathic and secondary forms

Diffuse pulmonary ossification (DiPO) is characterised by widespread ectopic bone formation in the lungs. Idiopathic DiPO (I-DiPO) poses significant diagnostic challenges and its ossification mechanism remains unclear. Cicatricial organising pneumonia (CiOP) lesions form fibrous nodules without damaging lung structure. We investigated the histopathological features of I-DiPO, focusing on the surrounding fibrosis, and compared them with those of secondary DiPO (S-DiPO). An analysis was conducted using data from a nationwide DiPO survey in Japan. The dataset included clinical, radiological, and histopathological data of patients with suspected I-DiPO. The specific patterns of ossification and fibrotic findings such as CiOP, organising pneumonia (OP), and subpleural fibrosis were identified. Eighteen and seven patients were classified as having I-DiPO and S-DiPO, respectively. I-DiPO affects younger patients, progresses slowly, commonly occurs in the lower lungs, and has a lower mortality rate. S-DiPO affects older patients, presents with widespread lung lesions, and has a higher mortality rate. CiOP lesions were found in direct continuity with or near ossified lesions in 61.1% and 71.4% of patients with I-DiPO and S-DiPO, respectively. OP, CiOP, and ossified lesions often observed in the same locations in S-DiPO. DiPO has a unique pathogenesis, with an ossification transition occurring via the CiOP lesions. These findings provide valuable insights for future diagnostic approaches and management strategies for this condition.

Hybrid assistive limb treatment for patients with severe cervical and thoracic myelopathy due to ossification of the posterior longitudinal ligament and ligamentum flavum: Feasibility, safety, and efficacy in the acute and chronic phases

Objective To assess the feasibility, safety, and efficacy of hybrid assistive limb (HAL) training in patients with varying levels of gait impairment caused by ossification of the posterior longitudinal ligament (OPLL) or ligamentum flavum (OLF). Design Prospective study. Setting July 2014 to May 2019; in – and out-patient rehabilitation unit. Participants: Twenty-five patients with varying levels of ossified lesions and acute, subacute, or chronic postoperative OPLL or OLF. Interventions Ten HAL training sessions (sixty min) in total; three times per week (acute/subacute patients) or one time per two months (chronic patients). Outcome Measures Walking Index for Spinal Cord Injury, American Spinal Injury Association (ASIA) Impairment Scale, ASIA motor score, Functional Independence Measure (FIM) motor score for activities of daily living, Berg Balance Scale, and Japanese Orthopedic Association score. Walking capabilities, including gait speed, step length, and cadence, were assessed using 10-meter and 2-minute walking tests (10/2MWT). Results All patients completed 10 HAL training sessions without severe adverse events. In the acute/subacute group, all measures showed significant improvements, except the 2MWT. In the chronic group, the gait speed, step length, and ASIA motor, FIM motor, and 2MWT scores significantly improved. Baseline and after-10-sessions estimated marginal means were compared for the acute, subacute, and chronic groups. All items were significant in the acute/subacute groups. In the chronic group, gait speed, step length, ASIA motor score, and 2MWT results were significant. Conclusion HAL treatment is feasible, safe, and effective in patients with different degrees of ossified lesions, specifically in those with OPLL or OLF. Trial Registration: UMIN000014336.

Combination metastasis-targeted external beam radiation therapy with 177Lu-PSMA-617 in patients with advanced castration-resistant prostate cancer.

Combination metastasis-targeted external beam radiation therapy with 177Lu-PSMA-617 in patients with advanced castration-resistant prostate cancer.

CT-guided biopsy of 18F-piflufolastat radiotracer avid lesions in osseous metastatic prostate disease: Initial experience, technical factors and biopsy yield.

CT-guided biopsy of 18F-piflufolastat radiotracer avid lesions in osseous metastatic prostate disease: Initial experience, technical factors and biopsy yield.

Unusual skull metastasis in colorectal adenocarcinoma.

Colorectal cancer ranks as the third most commonly diagnosed cancer globally. Research suggests that colon cancer and rectal cancer differ in terms of aetiology and risk factors. Follow-up is essential due to the detrimental impact of metastasis on patient survival (5-year survival rate of less than 20%). Routine use of positron emission tomography (PET-CT) is not recommended. This case report describes an elderly woman diagnosed who had previously been treated for rectal cancer. CT scans of the abdomen and chest showed no evidence of metastatic disease. During the second year of follow-up, a PET-CT was performed and a new active osseous lesion in the skull was identified. Current follow-up guidelines for colorectal carcinoma may not encompass all potential metastatic sites. Incorporating full body PET-CT scans into the follow-up protocol could be beneficial for detecting additional metastatic sites.

Reduced Vertebral Hounsfield Unit Values in the Bridging Group of Ossification-Related Segments in Patients with Ossification of the Posterior Longitudinal Ligament of the Cervical Spine.

Reduced Vertebral Hounsfield Unit Values in the Bridging Group of Ossification-Related Segments in Patients with Ossification of the Posterior Longitudinal Ligament of the Cervical Spine.

Intense Prostate-specific Membrane Antigen Avid Hepatic Metastatic Lesions Shortly After Finishing 6 Cycle Pluvicto Treatment: Challenging and Reflects.

A 71-year-old man was diagnosed with prostate cancer in 2012. After treatment with hormone, chemo, and combinations subsequently, the baseline prostate-specific membrane antigen PET scan revealed 130+ nodal and osseous metastatic lesions. After 4 doses of pluvicto, a partial response was appreciated. However, new intense prostate-specific membrane antigen avid hepatic lesions occupied around 30% of the liver with poorly differentiated metastatic prostate cancer 55 days after the last dose of pluvicto and markedly elevated prostate-specific antigen. This case highlights the need for vigilant monitoring and alternative treatment strategies.

Etiology of osteonecrosis and bone marrow edema

The frequent use of magnetic resonance imaging (MRI) introduced "bone marrow edema" (BME) as adescriptive radiological term for hyperintense signal changes in fluid-sensitive sequences. With the optimization of MRI soft tissue contrast, BME has evolved into avalid prognostic indicator associated with pain genesis, trauma, mechanical overload, and progressive cartilage and joint destruction. Both osteonecrosis and BME manifest in early MRI as intraosseous fluid accumulation, characterized by hyperintense signals in T2-weighted and STIR sequences. Conventional radiography and computed tomography (CT) are limited in BME detection due to the absence of relevant density alterations or structural osseous lesions early on. Although BME is not pathognomonic for osteonecrosis, it represents the initial phase of every primary osteonecrosis. BME can be transient (transitory osteoporosis) and regress without residuals or serve as aprodromal stage of manifest osteonecrosis. Primarily, it represents anon-specific reaction of bone marrow to various noxious stimuli such as trauma, mechanical overload, inflammatory processes, vascular insufficiency, or metabolic dysregulations. This review explores the pathophysiological mechanisms underlying BME, its clinical significance for osteonecrotic joint diseases, and its role in pain genesis.

Arthroscopic Management of Snapping Scapular Syndrome due to Recalcitrant Scapulothoracic Bursitis - A Case Series.

Snapping scapula syndrome (SSS) is a rare pathological condition characterized by palpable and/or audible crackling sensation during scapulothoracic movements. Scapulothoracic bursitis with or without osseous lesions is commonly associated with this syndrome. The initial management is always non-operative methods with anti-inflammatory medications and physiotherapy modalities. However, if the symptoms persist beyond 3-6 months of non-surgical treatment, it should be categorized as refractory or recalcitrant bursitis and necessitate either open or arthroscopic surgical excision of the lesion. We successfully managed five patients with SSS with arthroscopic scapulothoracic bursectomy. Arthroscopic scapulothoracic bursectomy is a successful surgical intervention for patients with scapulothoracic bursitis who do not respond to the conservative mode of management.

Deep Learning-Based Segmentation of Cervical Posterior Longitudinal Ligament Ossification in Computed Tomography Images and Assessment of Spinal Cord Compression: A Two-Center Study.

Deep Learning-Based Segmentation of Cervical Posterior Longitudinal Ligament Ossification in Computed Tomography Images and Assessment of Spinal Cord Compression: A Two-Center Study.

Baseline Imaging Derived Factors of Response Following [225Ac]Ac-J591 Therapy in Metastatic Castration-Resistant Prostate Cancer: A Lesion Level Analysis.

Actinium-225 labeled prostate-specific membrane antigen (PSMA) targeted radionuclide therapy has emerged as a potential treatment option in the management of men with metastatic castrate-resistant prostate cancer (mCRPC). This study investigated molecular imaging-derived parameters and compared imaging response of lesions categorized by tumor site. Men with mCRPC treated with [225Ac]Ac-J591 from 2017 to 2022 at our center on two prospective trials (NCT03276572 and NCT04506567) with pre- and post-treatment [68Ga]Ga-PSMA-11 Positron Emission Tomography (PET) imaging studies available were included. SUVpeak of the 3 most- and 3 least-avid lesions of the tumor sites were manually assessed. The median change of the SUVpeak from pre- to post-treatment per tumor site was evaluated using the paired Wilcox test. An objective response (OR) in the follow-up image was defined as complete or partial response using PET Response Criteria in Solid Tumors (PERCIST) 1.0. A total of 46 cases met the criteria for image review; most of them (n = 25, 54.3%) had more than one tumor site category. In total, 445 PSMA PET-positive lesions were assessed: 220 osseous, 163 nodal, 41 visceral, and 21 prostatic lesions. After treatment with [225Ac]Ac-J591, absolute SUVpeak values per tumor site declined significantly (p < 0.05) except for prostatic lesions (p = 1). The PERCIST-OR rate for osseous, nodal, visceral, and prostatic lesions was 53%, 28%, 56%, and 38%, respectively. [225Ac]Ac-J591 is an active treatment in men with mCRPC. Tumor distribution patterns may influence treatment response and potentially prognosis. Our findings warrant further validation in a larger cohort but may be considered in treatment planning and trial design.

68Ga]Ga‑FAPI PET/CT in the evaluation of Langerhans cell histiocytosis: comparison with [18F]FDG PET/CT.

We aimed to explore the value of [68Ga]Ga‑FAPI PET/CT for the evaluation of Langerhans cell histiocytosis (LCH) in comparison with [18F]FDG PET/CT. Thirty-two patients pathologically diagnosed with LCH were enrolled in this study. [68Ga]Ga‑FAPI and [18F]FDG PET/CT were performed within 1 week to identify disease extent and status. The detectability and intensity of the involved organs were compared between these two tracers. Thirty patients had active disease while two had non-active disease. In patients with active disease, the most commonly involved organ was bone (27/30), and [68Ga]Ga-FAPI PET/CT detected more osseous lesions (106/106) than [18F]FDG PET/CT (52/106). [68Ga]Ga-FAPI also identified liver, skin, and salivary gland involvement, which were often missed by [18F]FDG. Although both tracers detected thymus and pituitary gland involvement, [68Ga]Ga-FAPI demonstrated higher image contrast and more diagnostic confidence. Lymph node involvement, however, was not visualized by [68Ga]Ga-FAPI. Due to the superior sensitivity of [68Ga]Ga-FAPI, approximately 30% (10/30) of patients experienced reclassification in disease status or subtype. Furthermore, [68Ga]Ga‑FAPI appeared to be advantageous in response assessment. [68Ga]Ga-FAPI PET/CT outperforms [18F]FDG PET/CT in detecting osseous and extra-nodal lesions in LCH, providing a valuable tool for precise disease evaluation and treatment planning.

Clinical Experience with TNF Inhibition and Longitudinal Image Monitoring in Osseous Sarcoidosis.

In this case series, we present longitudinal imaging surveillance of 6 cases of osseous sarcoidosis, each of which was effectively treated with tumor necrosis factor (TNF) inhibition. We identified 6 patients from Brooke Army Medical Center with osseous sarcoidosis, who were treated with TNF inhibition and followed with longitudinal imaging studies. Cases of osseous sarcoidosis were defined as having pathologic evidence of noncaseating granulomas on bone biopsy and evidence of osseous lesions on imaging attributable to sarcoidosis by the radiologist, treating clinician, and reviewer. Clinical data were obtained through review of the military electronic medical record. Longitudinal imaging with positron emission tomography/computed tomography, magnetic resonance imaging, and bone scintigraphy assisted in the identification of active disease and clinical remission. Imaging progression of asymptomatic lesions was associated with the eventual development of bone pain 1 to 3 years later. Clinical remission was achieved in all six cases of osseous sarcoidosis and effective doses for TNF inhibition were adalimumab 40 mg subcutaneously every 1 to 2 weeks and infliximab 5 mg/kg every 6 to 8 weeks. Time to complete imaging response ranged from 3 to 8 months. Longitudinal imaging with bone scintigraphy, positron emission tomography/computed tomography, and magnetic resonance imaging demonstrated several benefits including evaluation for occult disease, surveillance of asymptomatic lesions, and evaluation of treatment response. TNF inhibition with adalimumab or infliximab was successful in all cases, and complete resolution of osseous lesions was demonstrated in 5 of 6 patients. Discontinuation of TNF inhibition led to disease recurrence in 2 cases, which prompted the use of long-term immunosuppressive therapy in all treated patients.

Metastatic Bone Disease: A Clinical Approach

Background: Advances in oncological management have contributed to longer survival of patients, even in the presence of metastases. Consequently, more patients would be expected to present with symptomatic bony metastases. The major objectives of orthopaedic surgical interventions in bone metastases include stabilization of impending or actual pathological fractures, restoration of mobility and gait, with resultant reduction in the overall morbidity during the survival period of the cancer patient.Purpose: This review was aimed at producing a synoptic material for ease of reference by students, trainees and young surgeons who come into contact with patients suffering from metastatic bone lesions.Methods: A review of the literature on the subject of metastatic bone diseases was done. Information on epidemiology, pathophysiology and mechanisms of bone metastases, clinical problems and concept of skeletal related events (SREs), differential diagnoses, diagnostic approach, general principles and options of treatment, and prognosis was extracted and presented.Conclusions: Metastatic lesions are the most common malignant tumours that affect the skeleton, and these malignant deposits in bones increase overall morbidity in cancer patients. Appendicular skeleton offers a large surface area for deposition of tumour cells from primary sites, including the breast, prostate, lung, kidney and thyroid, with the highest incidence coming from breast and prostate. The osseous lesions of primary malignant diseases predispose to pain, mechanical instability and fractures in the affected parts. These factors contribute to the overall morbidity and reduced survival in cancer patients.

MR Imaging Appearance of Long Bone Sarcoidosis

Sarcoidosis is a non-caseating granulomatous disease with common involvement of the lungs and lymph nodes. Osseous involvement is rare, with long bone involvement even rarer. Some of the characteristic MRI findings that point towards osseous sarcoidosis are presence of intra- or perilesional fat. Lesions that involve the long bones usually show no cortical destruction or periosteal reaction, in contrast to small bones, which show cortical destruction or extraosseous extension. In patients with diagnosed sarcoidosis, bone biopsy could be averted in patients having with characteristic findings on MRI. In patients without a diagnosis of sarcoidosis with multiple osseous lesions and aforementioned imaging findings, sarcoidosis can be provided on the differential diagnosis.

Conventional radiography for the assessment of focal bone lesions of the appendicular skeleton: fundamental concepts in the modern imaging era

AbstractBone lesions of the appendicular skeleton can be caused by primary benign or malignant tumors, metastases, osteomyelitis, or pseudotumors. Conventional radiography plays a crucial role in the initial assessment of osseous lesions and should not be underestimated even in this era of modern complex and advanced imaging technologies. Combined with patient age, clinical symptoms and biology, and lesion features including location, solitary versus multiplicity, density, margin (transitional zone evaluated with Lodwick-Madewell grading score), and, if present, the type of periosteal reaction and matrix mineralization can narrow the differential diagnosis or offer a likely diagnosis. These radiographic features help guide further follow-up or management.

Performance of PSMA-PET/CT as verified by bone biopsy for diagnosing osseous metastases of prostate cancer.

Prostate-specific membrane antigen (PSMA)-PET/CT has shown considerable promise in the evaluation of prostate cancer bone metastases; however, data utilizing a histopathologic reference standard in this setting are limited. We therefore sought to evaluate the diagnostic performance of PSMA-PET/CT using a consistent histopathologic gold standard in the form of bone biopsy. In this single-center, retrospective study, we identified 80 patients with prostate cancer who underwent CT-guided bone biopsy of a tracer-avid osseous lesion on PSMA-PET/CT performed with 18F-piflufolastat. Concordance between PET/CT and histopathology and the positive predictive value of PSMA-PET/CT were determined. Factors predictive of positive biopsies were also evaluated. PSMA-PET/CT and bone biopsy results were concordant in 55/80 patients (69%), and the positive predictive value of PSMA-PET/CT for osseous metastasis of prostate cancer was 66% (53/80). Positive predictive values for spine, pelvis, and rib biopsies were 82% (23/28), 72% (18/25), and 26% (5/19), respectively. Peak SUV and its ratio to liver mean SUV were significantly higher in biopsy-positive lesions compared to biopsy-negative lesions. A threshold peak SUV to liver mean SUV ratio of 1.7 had a sensitivity of 61% and a specificity of 92% for a histopathologic diagnosis of metastatic prostate cancer. PSMA-PET/CT has a moderately high histopathologic concordance and positive predictive value for the diagnosis of osseous metastatic disease in prostate cancer. Peak SUV is useful for distinguishing biopsy-positive from biopsy-negative lesions. In keeping with prior investigations, a majority of biopsied rib lesions were negative for metastatic prostate cancer.

Navigating the Diagnostic Maze: A Case Report of Uncommon Cardiac Metastasis in Childhood Ewing Sarcoma

AbstractEwing sarcoma is a bone cancer affecting children and young adult males. It usually presents as a single bone tumor, but it can also occur in multiple locations. Nevertheless, Ewing sarcoma is an extremely aggressive tumor capable of metastasizing to other parts of the body, such as the lungs, bones, liver, and lymph nodes. Cardiac metastases are rare, indicating a poor prognosis, as they suggest that the cancer has become more advanced and challenging to treat.This case report describes a 9-year-old boy who presented with complaints of fever and multiple swellings in the calvaria, periorbital region, clavicle, and left thigh. Laboratory investigations revealed a high erythrocyte sedimentation rate, elevated absolute neutrophil count, high phosphate and calcium levels, and low magnesium levels. Computed tomography imaging revealed the presence of multifocal osseous expansile lytic lesions, multiple pulmonary metastases, and extensive soft tissue involvement of the heart. Based on these findings, possible differential diagnoses of Langerhans cell histiocytosis, lymphoma, and Ewing sarcoma were considered. Further histopathological examination and immunohistochemistry confirmed a final diagnosis of metastatic Ewing sarcoma.The most common metastasis sites for Ewing sarcoma are the lungs, with rare occurrences in the central nervous system, and metastasis to the heart is uncommon. We present here a rare undiagnosed Ewing sarcoma with cardiac metastasis, in addition to pulmonary and multifocal osseous metastasis. This case is unique because multifocal osseous involvement is rare and further lung and heart involvement is even rarer in Ewing sarcoma.

FDG PET/CT Scan Still Can Help in Evaluation of Prostate Cancer.

Although 18F-FDG PET/CT scan is not the preferred modality to evaluate prostate cancer patients due to generally low uptake of FDG in prostate cancer cells, it can still be helpful in some selected cases with diagnostic dilemma. Here we are presenting an unusual prostate cancer case, status post radical prostatectomy, with heterogenous uptake in osseous lesions on 68Ga-PSMA PET/CT scan and low PSA values. He was referred for further evaluation with 18F-FDG PET/CT scan, revealing widely metastatic lesions in bone and liver, in addition to mildly avid recurrence in prostatectomy surgical bed and also metastasis in the spleen.