CHARACTERIZATION OF OSTEOCORTICAL-PERIOSTEAL LAYERS BY HIGH-RESOLUTION SONOGRAPHY USING A DOPPLER TECHNIQUE IN PAGET'S DISEASE OF BONE

The authors characterize some aspects of Paget's disease of bone, comparing clinical and radiographic findings with sonographic features; they also demonstrate the utility of sonography and the Doppler technique for the diagnosis and follow-up of Paget's disease. Two sonographic instruments were used to study the bone profile, periosteal layer, and vascularization by high-resolution sonography and color Doppler. Thirteen patients were studied between May 2006 and May 2007. The morphology of cortical bone in Paget's disease analyzed by sonography is comparable to what can be detected by X-rays. The bone profile becomes wavy, and the loss of interface linearity ends up in a loss of echogenicity; only where the interface is still reflecting are some hyperechoic tracts visible. The periosteal layer becomes thicker and forms a fibrillar echoic band between bone and overlying muscle. Color Doppler techniques show cortical hyperflow and low-capillary resistance, suggesting the absence of arteriovenous fistulae, thus confirming data observed with other techniques. Sonographic techniques display the osteoperiosteal-layer hypervascularization, a marker of active disease, thus enabling an evaluation of disease activity, both at the diagnosis and during follow-up