Imaging of Paget’s disease of bone

Abstract

Paget's disease of bone is a disorder of bone remodelling, leading to changes in the architecture and overall appearance of the bone. The disorder may be monostotic or polyostotic and affect any bone in the body, although most commonly it involves the spine, pelvis, skull and femur. This article explores the different imaging modalities used in the assessment of Paget's disease of bone in its different phases. The relative merits of each imaging modality is discussed with illustrative examples, in particular with respect to radiographs, nuclear medicine bone scan, computed tomography (CT) and magnetic resonance imaging (MRI).

Misdiagnosis of Paget’s Disease of Bone in a Congenital Generalized Lipodystrophy Patient: Case Report

“…In appendicular sites, there were signs of sclerosis, pseudo-osteopoikilosis, as well as radiolucent areas with symmetrical bone cysts in greater trochanter bilaterally, which are common findings in CGL1. Bone involvement in PDB is usually asymmetric, and true cysts have not been described in this disease (10,(12)(13)(14). He had no lytic lesions on the skull, enlargement of bone on radiological analyses, deformity or fractures, which along with repeatedly normal AP levels, led us to suspect the misdiagnosis of PDB.…”

“…The radiological findings correlate to the phase of the disease. Initially, osteoclastic activity is increased, leading to osteolytic lesions in skull and long bones, in which radiolucency areas can assume the pattern of “blade of grass” ( 13 ). In the skull, lytic lesions can be present in the occipital and frontal bones ( 14 ).…”

“…The high rate of bone formation comes after the initial phase, resulting in sclerosis along with the lytic lesions. In the final and inactive phase, sclerosis is the predominant feature ( 13 ). Although any bone can present both sclerosis and lytic lesions, the axial skeleton is more frequently affected [pelvis (70%), lumbar spine (53%), skull (42%)].…”

Fibrous Dysplasia, Paget's Disease of Bone, and Other Uncommon Sclerotic Bone Lesions of the Craniofacial Bones

“…19,20 There is a slight male predilection with a 1.6:1 male-to-female ratio. 21 It is currently believed that the etiology is complex, and several genes were postulated as causative factors. 22,23 Clinical Features PD remains mostly asymptomatic.…”

Paget's disease of bone in two medieval skeletons from Poulton Chapel, Cheshire, UK

“…This results with newly formed bone being disorganized (woven) and mechanically weaker, overall resulting in skeletal lesions with abnormal bone architecture (Shaw et al, 2019). Typically, PDB affects one (monostotic) or more (polyostotic) skeletal elements, with research supporting a higher prevalence of the monostotic type of this disease (Winn, Lalam, & Cassar-Pullicino, 2016). Although PDB can affect any bone in the human skeleton, it is most frequently reported to affect the axial skeleton (e.g., skull, lumbar spine, pelvis, sacrum, femur and tibia; see Cundy, 2018;Ralston et al, 2019), and despite a steady decrease in secular changes (Abdulla, Naqvi, Shamshuddin, Bukhari, & Proctor, 2018), it is one of the most common metabolic bone disorders after osteoporosis (Vallet & Ralston, 2016).…”