Radiographic appearance of fibrous dysplasia in McCune-Albright syndrome

(A) A proximal femur with typical ground-glass appearance and shepherd's crook deformity characteristic of FD in a 10-year-old child.
(B) The appearance of FD in the femur of an untreated 40-year-old man demonstrates the tendency for FD to appear more sclerotic with time.
(C) The typical ground-glass appearance of FD in the craniofacial region on a CT image of a 10-year-old child is shown. The white arrows indicate the optic nerves, which are typically encased with FD.
(D) A CT image in a 40-year-old woman demonstrates the typical appearance of craniofacial FD in an older person, with mixed solid and "cystic" lesions. The Hounsfield Unit measurements of "cystic" lesions are quite useful in distinguishing soft tissue "cystic" lesions from true fluid-filled cysts, which are much more uncommon and tend to behave aggressively with rapid expansion and compression of vital structures.
(E to G) Bone scintigraphy in FD. Representative 99Tc-MDP bone scans, which show tracer uptake at affected skeletal sites, and the associated skeletal disease burden score are shown.

• (E) A 50-year-old woman with monostotic FD confined to a single focus involving contiguous bones in the craniofacial region.
• (F) A 42-year-old man with polyostotic FD shows the tendency for FD to be predominantly (but not exclusively) unilateral and to involve the skull base and proximal femur.
• (G) A 16-year-old boy with McCune-Albright syndrome and involvement of virtually all skeletal sites (panostotic) is shown.