Which radiographic pattern is typical of Paget disease of bone?

Which radiographic pattern is typical of Paget disease of bone?

• A. Purely lytic changes
• B. Purely sclerotic changes
• C. Ground-glass changes
• D. Mixed lytic/sclerotic changes with cotton-wool skull

Answer: (D)

Paget disease reflects abnormal bone remodeling, with phases of rapid resorption followed by excessive new bone formation. This results in a mixed pattern on radiographs rather than a single type of change. In the skull, the disorganized, patchy sclerosis from the new bone formation produces a distinctive cotton-wool appearance. The combination of both lytic and sclerotic changes together with the cotton-wool skull is the classic radiographic hallmark of Paget disease. Purely lytic or purely sclerotic patterns are not typical for Paget, and a ground-glass look is more associated with fibrous dysplasia, making the mixed lytic/sclerotic pattern with cotton-wool skull the best descriptor.

Paget disease reflects abnormal bone remodeling, with phases of rapid resorption followed by excessive new bone formation. This results in a mixed pattern on radiographs rather than a single type of change. In the skull, the disorganized, patchy sclerosis from the new bone formation produces a distinctive cotton-wool appearance. The combination of both lytic and sclerotic changes together with the cotton-wool skull is the classic radiographic hallmark of Paget disease. Purely lytic or purely sclerotic patterns are not typical for Paget, and a ground-glass look is more associated with fibrous dysplasia, making the mixed lytic/sclerotic pattern with cotton-wool skull the best descriptor.