Dynamic computed tomography scanning of benign bone lesions: Preliminary results

Abstract

The majority of benign bone lesions can be evaluated adequately using conventional radiologic techniques. However, it is not always possible to differentiate reliably between different types of benign bone lesions on the basis of plain film appearances alone. Dynamic computed tomography (CT) scanning provides a means for further characterizing such lesions by assessing their degree of vascularity. Thus, it may help in distinguishing an osteoid osteoma, which has a hypervascular nidus, from a Brodie's abscess, which is avascular. Dynamic CT scanning may also help in the differentiation between a fluid-containing simple bone cyst, which is avascular, and other solid or semi-solid benign bone lesions which show varying degrees of vascularity. However, because of the additional irradiation involved, dynamic CT scanning should be reserved for evaluation of selected patients with benign bone lesions in whom the plain film findings are not definitive and in whom the CT findings may have a significant influence on management.

Benign bone tumors and tumor-like lesions: value of cross-sectional imaging

“…If the nidus is located in cancellous bone, CT morphology alone may not allow differentiation of osteoid osteoma from chronic osteomyelitis (Brodie's abscess); however, since the nidus in osteoid osteoma shows marked vascularity and the nidus in chronic osteomyelitis represents an intraosseous abscess, the two entities demonstrate different enhancement patterns on dynamic CT. Osteoid osteoma usually shows early peak enhancement that parallels enhancement of neighboring arterial vessels, whereas Brodie's abscess demonstrates slow and gradual enhancement or even no measurable contrast uptake at all ( Fig. 2) [13,14]. Especially prior to CT-guided percutaneous treatment by means of thermocoagulation or drilling, where histologic verification can be difficult to obtain, dynamic CT has proved to be valuable in distinction of the two conditions [10].…”

Combined dynamic contrast-enhancement and serial 3D-subtraction analysis in magnetic resonance imaging of osteoid osteomas

“…3). Brodie's abscess may be morphologically indistinguishable from a nidus in MR [8] as well as in CT images [5,6,16,18,19]. In our experience, the contrast enhancement in chronic osteomyelitis increases more gradually than in osteoid osteomas and shows no clear-cut decrease (wash-out effect) in the late phase.…”

“…6). These characteristic vascular enhancement patterns have been previously reported for single cases of osteoid osteomas examined with CT [6,18,19], MRI [17,24,25], scintigraphy [1], and angiography [1]. MRI studies focusing on enhancement kinetics of the nidus and its surroundings have been limited to small numbers of patients [11,12].…”

“…Diagnosis by CT may be difficult in intra-articular and medullary osteoid osteomas [1,8,9]. Based on experiences with small numbers of histologically confirmed lesions, dynamic contrast-enhanced CT has been recommended to identify a nidus [16,18,19].…”

Osteoid osteoma and osteoid osteoma-mimicking lesions: biopsy findings, distinctive MDCT features and treatment by radiofrequency ablation

“…Unenhanced MDCT might then not be sufficient for the work-up of all small painful radiolucent bone lesions, especially when located in the medulla. In those cases, contrast-enhanced techniques such as dynamic CT [20] and dynamic MRI [15] have improved diagnostic accuracies.…”