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Imaging of Paget's Disease and Fibrous Dysplasia of Bone

PAGET’S DISEASE OF bone is a frequently encountered incidental finding on radiographs and scintigrams. Radiographically, the intermediate phase of Paget’s disease expressed by sclerosis, lysis, thickened trabecula, and cortices is not usually a diagnostic challenge when encountered in the pelvis, calvaria, ends of long tubular bones, and vertebra. The purely lytic form of Paget’s disease, the sclerotic form without bone expansion, and the combination of lytic Paget’s in an a-typical location such as the tibial tubercle continue to be diagnostically confounding in comparison with its occurrences in characteristic locations in the intermediate phase of the disease. This review will be confined to the atypical form of Paget’s disease and the role of MRI in separating uncomplicated Paget’s disease from its wellrecognized complications, albeit rare, of superimposed sarcoma. Virtually any bone can be affected by Paget’s disease, and because the disease is more often asymptomatic than symptomatic, radiologists, perhaps more than most physicians, frequently encounter the disease in well-recognized locations such as the pelvis or vertebra and in less wellidentified or -recognized locations such as the sacral ala or metacarpals. This is usually the case when imaged for staging of a malignancy or symptoms after trauma.