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Intramedullary Osteosclerosis: Imaging Features in Nine Patients¹

¹ From the Departments of Radiology (K.C., C.B.C., Y.M.L., D.R.) and Pathology (P.H.), Veterans Affairs Medical Center, University of California–San Diego, 3350 La Jolla Village Dr, San Diego, CA 92161. From the 2000 RSNA scientific assembly. Received July 26, 2000; revision requested September 7; final revision received December 11; accepted January 5, 2001. Address correspondence to D.R. (e-mail: dresnick@ucsd.edu).

PURPOSE: To determine the conventional radiographic, computed tomographic (CT), magnetic resonance (MR) imaging, scintigraphic, and histologic features of intramedullary osteosclerosis and to review the clinical features.

MATERIALS AND METHODS: Nine female patients with leg pain and imaging features indicative of intramedullary sclerosis were seen during a 25-year period. None of the patients had a history of trauma or infection, familial bone disease, or related abnormal laboratory findings. Imaging studies included radiography (n = 9), CT (n = 4), MR imaging (n = 5), and skeletal scintigraphy (n = 5). Histologic correlation was available in five patients.

RESULTS: Sixteen bone lesions (midtibia, n = 14; distal fibula, n = 1; and proximal femur, n = 1) were evident. Both lower extremities were involved in seven patients, and a single extremity was involved in two. Intramedullary sclerosis was present, as was cortical thickening, mainly in the diaphysis of the long bones, without extensive periosteal reaction or soft-tissue involvement. Findings at bone scintigraphy were positive in all lesions. Histologic analysis showed nonspecific changes of markedly sclerotic bone with a variable degree of mineralization and maturity.

CONCLUSION: Intramedullary osteosclerosis is a distinct disorder that typically affects the diaphysis of one or both tibiae in women. Characteristic imaging findings, when coupled with clinical information, allow precise diagnosis.

Index terms: Bones, CT, 45.1211 • Bones, MR, 45.1214 • Bones, radionuclide studies, 45.12172 • Bones, sclerosis, 45.5322 • Fibula, 45.5322 • Intramedullary osteosclerosis, 45.5322 • Tibia, 45.5322

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