Radiological signs of Paget's disease.

Paget's disease is characterized by progressive bony deformity, with disorganized and excessive bone resorption and proliferation resulting in trabecular coarsening, cortical thickening, and generalized osseous enlargement. Radiologically, it is most often confused with blastic metastatic disease. Examples of the classic radiological signs of Paget's disease during its three phases (osteolysis, osteosclerosis superimposed on osteolysis, and predominant osteosclerosis) are collected and examined. Classical radiological signs of Paget's disease include osteoporosis circumscripta, blade of grass presentation, flame shaped lesions, cotton wool appearance, osteosclerosis, periosteal new bone formation, increased thickness and circumference of bone, trabecular disorganization, compression from softening of bone, separation and displacement of teeth, hypercementosis, thickening of the iliopubic and ilioischial lines, ivory vertebrae, picture-frame vertebrae, enlarged cranium with increase in the marrow space, and intense uptake of radioactive tracers by involved bone. Complications of Paget's disease include basilar impression, cranial nerve palsy secondary to narrowed neural foramina, pathological fractures, and malignant degeneration. Recognition of the classic radiographic signs and complications of Paget's disease allows the radiologist to make the diagnosis with accuracy and confidence.

W. Mel Flowers, Jr, MD, FACR. Department of Radiology, University of Mississippi Medical Center, Jackson, MS.