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Diagnostic Imaging of Paget's Disease

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Diagnostic Imaging of Paget's Disease

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Diagnostic Imaging of Paget's Disease

  1. 1. Musculoskeletal Paget's Disease
  2. 2. Mohamed Zaitoun Assistant Lecturer-Diagnostic Radiology Department , Zagazig University Hospitals Egypt FINR (Fellowship of Interventional Neuroradiology)-Switzerland zaitoun82@gmail.com
  3. 3. Knowing as much as possible about your enemy precedes successful battle and learning about the disease process precedes successful management
  4. 4. Paget's Disease (Osteitis Deformans) a) Incidence b) Location c) Types d) Radiographic Features
  5. 5. a) Incidence : -Chronic bone disorder characterised by excessive abnormal bone remodelling -It is relatively common in older adults, can affect up to 4% of individuals over 40 and up to 11% over the age of 80 -Usually polyostotic and asymmetrical
  6. 6. b) Location : -Pelvis -Spine -Skull -Proximal long bone
  7. 7. c) Types : 1-Active phase (lytic phase, osteoclastic activity): -Aggressive bone resorption : lytic lesions with sharp borders that destroy cortex and advance along the shaft (candle flame, blade of grass) 2-Inactive phase (quiescent phase, osteoblastic activity) : -New bone formation and sclerosis : thickening of cortex and coarse trabeculations 3-Mixed pattern (lytic and sclerotic phases coexist) : -Bowing of bones becomes a prominent feature
  8. 8. d) Radiographic Features : 1-Classic Triad 2-Pelvis 3-Spine 4-Skull 5-Long Bones
  9. 9. 1-Classic Triad : -Thickening of the cortex -Accentuation of the trabecular pattern -Increased size of bone
  10. 10. 2-Pelvis : -Thickening of iliopubic (iliopectineal), ilioischial lines (early signs) -Thickening of trabeculae -Protrusio acetabuli (acetabular protrusion), intrapelvic displacement of the medial wall of the acetabulum
  11. 11. Cortical thickening of the pelvic bones seen more along the bilateral ilioischial lines as well as thickening of trabeculations
  12. 12. Normal Pelvis Protrusio Acetabuli
  13. 13. Bilateral acetabular protrusio (white arrows) , the femoral head should not extend medial to a line drawn from the lateral aspect of the pelvis and the lateral aspect of the obturator foramen (blue line) , The distance between the acetabulum and the ilioischial line (yellow arrow) should not be > 3mm in males and >6 mm in females
  14. 14. -N.B. : Causes of Protrusio Acetabuli : My PROTRUSIO 1-Marfan syndrome 2-Paget’s disease , Primary protrusio acetabuli 3-Rheumatoid arthritis 4-Osteogenesis imperfecta 5-Trauma 6-Rickets 7-Unknown (idiopathic) 8-S , Psoriatic arthritis 9-Inflammatory arthritis (ankylosing spondylitis) 10-Osteomalacia
  15. 15. 3-Spine : -Picture frame vertebral body : enlarged square vertebral body with peripheral thick trabeculae and inner lucency (increased opacity of the cortex on all sides of the vertebral body whereas the characteristic sclerosis of the rugger jersey spine is seen only at the superior and inferior endplates) -Ivory vertebra
  16. 16. Picture frame vertebral body
  17. 17. Picture frame Rugger jersey
  18. 18. Sandwich vertebra Rugger-jersey picture frame (Osteopetrosis) (HPT) (Paget’s)
  19. 19. 4-Skull : -Osteoporosis circumscripta : osteolytic phase, commonly seen in frontal bone (radiolucent regions of the skull on plain film) -Cotton-wool appearance : mixed lytic-sclerotic lesions -Inner and outer table involved : diploic widening -Basilar invagination with narrowing of foramen magnum : cord compression -Neural foramen at base of skull may be narrowed : hearing loss, facial palsy & blindness
  20. 20. *N.B. : Causes of basilar invagination : a) Congenital : 1-Osteogenesis imperfecta 2-Achondroplasia 3-Cleidocranial dysplasia 4-Chiari I & II malformations 5-Klippel-Feil syndrome b) Acquired : (HOPR) 1-Rheumatoid arthritis 2-Paget's disease 3-Hyperparathyroidism 4-Osteomalacia / rickets
  21. 21. Osteoporosis circumscripta of frontal bone is lytic phase of Paget's disease
  22. 22. Osteoporosis circumscripta
  23. 23. Lateral skull radiograph shows a large geographic, lytic lesion in the left frontal bone (blue arrows). Also seen are islands of bone (white arrows) producing a "cotton-wool" appearance
  24. 24. Osteoporosis circumscripta
  25. 25. Cotton wool sign
  26. 26. Cotton wool sign
  27. 27. 5-Long Bones : -Thickening of cortex and enlargement of bone -Candle flame (Blade of grass) : V-shaped lytic lesion advancing into diaphysis -Lateral curvature of femur -Anterior curvature of tibia (commonly resulting in fracture)
  28. 28. V-shaped lucency (white arrow) in metaphysis of femur from the lytic phase of Paget disease
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Diagnostic Imaging of Paget's Disease

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