Paget's Disease or Densifying Metastasis: How to Sort It Out

Area of Science:

• Radiology
• Orthopedic Imaging
• Bone Diseases

Background:

• Paget's disease prevalence has declined but remains a diagnostic consideration.
• Incidental imaging findings are common, necessitating accurate interpretation.
• Distinguishing Paget's disease from bone metastases is a clinical challenge.

Approach:

• This review synthesizes current knowledge on Paget's disease imaging.
• It focuses on characteristic radiographic and advanced imaging features.
• Rare and atypical presentations are also discussed.

Key Points:

• Typical imaging findings include bone expansion, cortical thickening, and mixed lytic-sclerotic lesions.
• Unusual presentations may involve monostotic involvement or mimic aggressive bone lesions.
• Advanced imaging modalities like MRI and CT can aid in complex cases.

Conclusions:

• Accurate diagnosis of Paget's disease relies on recognizing typical and atypical imaging patterns.
• Radiologists must be aware of potential mimics, especially in the context of malignancy.
• This review provides a guide for identifying Paget's disease across its spectrum of presentations.