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Radiologic findings will vary in accordance with the relative activities of the osteoclasts and osteoblasts. The lesions are clearly demarcated and confined to individual bones. The joint spaces are not crossed.
Patchy areas of increased radiolucency are characteristic of the osteolytic stage. Classically, flame shaped areas of osteopenia are seen extending along the bone shaft. In the skull, the patches are circumscribed.
The sclerotic phase is characterised by increased bone density. The bones are enlarged and irregular with coarse trabeculation. New bone may impinge on the medulla from the cortex.
Fine cracks are often seen on the tension surfaces of the femur and tibia.
Isotope bone scans can be helpful in defining the extent of Paget's disease in the skeleton - there is preferential take-up of the isotope technetium in the Pagetic foci.
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