Imaging of solitary and multiple osteochondromas: From head to toe — A review

• Published in: Clinical imaging 2023-11, Vol.103, p.109989-109989, Article 109989
• Main Authors: Pontes, Írline Cordeiro de Macedo, Leão, Renata Vidal, Lobo, Carlos Felipe Teixeira, Paula, Vitor Tavares, Yamachira, Viviane Sayuri, Baptista, Andre Mathias, Helito, Paulo Victor Partezani
• Format: Article
• Language: English
• Subjects: Imaging; Magnetic resonance; Multiple exostosis; Osteochondroma
• ISSN: 0899-7071; 1873-4499
• DOI: 10.1016/j.clinimag.2023.109989

Osteochondromas account for 20%–50% of all benign bone lesions. These tumors may present as solitary non-hereditary lesions, which are the most common presentation, or as multiple tumors associated with hereditary conditions. Plain radiography is the imaging method of choice and demonstrates the typical cortical and medullary continuity of the tumor with the underlying bone. Magnetic resonance imaging is often performed to evaluate cartilage cap thickness, which correlates with malignant transformation. Other local complications include compression of adjacent neurovascular bundles, muscles, and tendons, bursitis, tendon tears, stalk fracture, and angular or rotational long bone deformities. Although the imaging features of osteochondromas are largely known, only a few papers in the literature have focused on their main complications and image-based follow-up. This paper aimed to illustrate the main complications of osteochondromas, suggest an image-based algorithm for management and follow-up and discuss differential diagnosis. •Osteochondromas are bone exostosis with cortical and medullary continuity with the underlying bone, mostly located at long bones metaphysis, growing away from the physis.•MR is the best method to evaluate osteochondromas complications such as malignant transformation, neurovascular and myotendinous compression, and bone deformities.•Malignant transformation present with tumor enlargement after skeletal maturity, erosions, excessive scattering or irregular calcifications and thickened cartilage cap (>2 cm).•MR and clinical follow-up are recommended for growing osteochondromas in the mature skeleton and surgical resection may be required for symptomatic or large lesions.