Wide area detector CT perfusion: can it differentiate osteoid osteomas from other lytic bone lesions?

Abstract

Purpose: To compare the enhancement dynamics of osteoid osteomas with other benign and malignant lytic bone lesions using CT perfusion.

Patients and methods: CT perfusion parameters of 15 patients with a final diagnosis of osteoid osteoma, 15 patients with lesions that mimic osteoid osteomas and 26 patients with other bone lytic lesions were compared.

Results: Enhancement curve morphology of the osteoid osteomas was significantly different from its mimickers. All osteoid osteomas had an early enhancement with a delay between nidus and arterial peak below 30 seconds. Eighty percent of the mimickers demonstrated a slow and progressive enhancement. The perfusion parameters of the other lytic bone lesions were similar to those of the osteoid osteomas in 46.1% of the patients.

Conclusion: Early enhancement is suggestive but not pathognomonic of osteoid osteomas. Absent or delayed enhancement in similar lesions should evoke an alternative diagnosis. The same contrast enhancement dynamics of osteoid osteomas can be seen in other bone lesions, both malignant and benign.

Keywords: Bone neoplasms; Differential diagnosis; Multidetector computed tomography; Osteoid osteoma; Perfusion imaging.