Background: In general, ISSD may be detected due to clinical symptoms, but some ISSDs are found incidentally during radiological examinations for the assessment of unrelated diseases. This study aims to evaluate the clinical aspects of all ISSDs detected by image inspection. Methods: A total of 94 patients with ISSD were enrolled in this study. The study patients were classified into two groups: a group who improved with conservative treatment (n=25), and a group who did not improve with conservative treatment (n=69). Their clinical symptoms, medical histories, pathologies, and imaging findings were assessed.Results: The incidence of high signal intensity on T2-weighted images in the improvement group was significantly higher compared with the non-improvement group. Conversely, the incidences of bone erosion and expansion were significantly higher in the non-improvement group. Of the 42 cases receiving surgery, 10 cases (23.8%) had asymptomatic ISSD.Conclusion: This study suggests that ISSD with high signal intensity on T2-weighted images and/or without bone erosion and expansion in imaging findings could improve by conservative treatment or watchful waiting. Because some asymptomatic ISSD cases required surgery, proper diagnosis of ISSD regardless of clinical symptoms is important to prevent severe illness.