PD is often incidentally diagnosed in plain radiographs that were obtained for other reasons. The radiological hallmarks of PD include coarse trabeculae, thickened cortical bones, lytic areas (osteoporosis cir-cumscripta) interspersed with dense sclerotic bone, and bony deformities. In typical cases sclerosis may occur in the vertebral margins resulting in "picture frame" vertebrae (Figures 12-1A and 12-1B). Rarely, diffuse, intense sclerosis of the entire vertebral body results in an "ivory" vertebra, which frequently looks like metastatic disease (prostate, breast, lymphoma). After prolonged periods of bone resorption and bone formation the affected bones thicken, enlarge, and, at times, deform. The adjacent soft tissues, however, remain normal. Bone scan should be obtained in order to establish the distribution of the disease.
CT and MRI studies should be obtained whenever coexisting pathology, malignant transformation, or other complications such as fracture, spinal stenosis, or myelopathy are suspected.
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