Axial T2 wt image at L3 level and coronal STIR image : Cortical thickening and irregularity with trabecular thickening. STIR hyperintense signals seen in vertebral body |
Mid sagittal T2 wt image of cervical spine: Diffuse uniform thickening of cranial vault with hyperintense marrow. |
Also called as osteitis deformans.
The spine is the second most commonly affected site after the pelvis.
Three phases:
1. Osteolytic
2. Mixed
3. Osteoblastic
Most common sites of involvement: Lumbar spine> pelvis> sacrum> femur> cranium.
Radiography:
Blade of grass- early lytic phase in long bones. Spreads about 1cm per year and has no sclerotic margin.
Osteoporosis circumscripta: large areas of advancing osteolysis in frontal and occipital regions of cranial vault. More prominent in inner table and can cross sutures.
In mixed phase - Picture frame vertebra and cotton wool appearance of skull. Ileopectineal and ischiopubic line thickening.
In late blastic phase: Banana fractures, Tam-o-shanter skull, Ivory vertebra.
Radionuclide scan:
shows increased uptake in all the three phases, but more so in active phase.
CT scan:
Shows the classic features of Pagets conspicuously and helps in evaluation of complications like fractures, spinal stenosis and malignancy.
MRI:
MR signal changes reflect the natural coarse of disease.
Three major patterns:
1. Similar to fat- corresponds to long standing disease.
2. Heterogenous low signal on T1 and high signal on T2 - early mixed active phase
3. Low signal on both T1 and T2 - late blastic inactive phase.
Complications:
1. Arthropathy
2. Deformity/ fracture
3. Nerve entrapment
4. Neoplasms – sarcomatous transformation(osteosarcoma > MFH > chondrosarcoma > lymphoma & angiosarcoma.
References:
· Imaging of Paget Disease of Bone and Its Musculoskeletal Complications: Review AJR:196, June 2011.
· The spine in Paget’s disease, Skeletal Radiol (2007) 36:609–626
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