Study Distinguishes Untreated Osteoblastic Metastases from Benign Bone Lesions Using CT Attenuation Measurements

Leesburg, VA, August 17, 2016—A team of Boston researchers found that CT attenuation measurements can be used to distinguish untreated osteoblastic (bone-related) metastases from enostoses (benign bone lesions). Based on this conclusion, some biopsies and additional radiologic studies could be avoided, according to a paper published in the August 2016 issue of the American Journal of Roentgenology .

“While imaging has become an integral part of diagnosing patients presenting with malignancy, it can be confusing when an osteoblastic lesion is identified in the presence and absence of a primary malignancy,” said Connie Y. Chang, Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital in Boston. “As CT use has increased, the frequency of incidentally detected lesions has also increased” [1].

Chang is the corresponding author associated with the retrospective study, “Distinguished Untreated Osteoblastic Metastases from Enostoses Using CT Attenuation Measurements,” which is available through open access on ARRS ’s website at

The study group comprised 62 patients with 279 sclerotic bone lesions found at CT (126 enostoses in 37 patients and 153 metastases in 25 patients). While the authors admitted that the sample size was small, the study concluded that a mean CT attenuation of 885 Hounsfield units (HU) and a maximum attenuation of 1050 HU provide reliable thresholds below which a metastatic lesion is the favored diagnosis. The HU is a quantity commonly used in CT scanning to express CT numbers in a standardized and convenient form.1

The detection of metastatic disease is crucial because it allows accurate diagnosing and determination of prognosis and can drastically change treatment, the study said. The most common malignancy of bone is metastatic disease, affecting approximately 400,000 people in the United States each year [2, 3]. Prostate, breast, and lung cancer account for approximately 80% of skeletal metastases [2–6]. A problem arises when an osteoblastic lesion does not have typical features of a benign entity, such as an enostosis.


  1. Berland LL, Silverman SG, Gore RM, et al. Managing incidental findings on abdominal CT: white paper of the ACR incidental findings committee. J Am Coll Radiol 2010; 7:754–773
  2. Mavrogenis AF, Angelini A, Vottis C, et al. Modern palliative treatments for metastatic bone disease: awareness of merits, demerits and guidance. Clin J Pain 2016; 32:337–350
  3. Sutcliffe P, Connock M, Shyangdan D, Court R, Kandala N-B, Clarke A. A systematic review of evidence on malignant spinal metastases: natural history and technologies for identifying patients at high risk of vertebral fracture and spinal cord compression. Health Technol Assess 2013; 17:1–274
  4. Smith HS, Barkin RL. Painful boney metastases. Am J Ther 2014; 21:106–130
  5. Tsuya A, Fukuoka M. Bone metastases in lung cancer (in Japanese). Clin Calcium 2008; 18:455–459
  6. Janjan N. Bone metastases: approaches to management. Semin Oncol 2001; 28:28–34

1. Weerakkody, Y, Greenway, K, et al. Accessed August 15, 2016

Founded in 1900, ARRS is the first and oldest radiology society in the United States, and is an international forum for progress in radiology. The Society's mission is to improve health through a community committed to advancing knowledge and skills in radiology. ARRS achieves its mission through an annual scientific and educational meeting, publication of the American Journal of Roentgenology (AJR) and InPractice magazine, topical symposia and webinars, and print and online educational materials. ARRS is located in Leesburg, VA.