Which plain-film radiographic pattern is associated with Paget's disease?

• A. Salt-and-pepper pattern
• B. Sunburst pattern
• C. Ground-glass pattern
• D. Lytic moth-eaten pattern

Answer: (A)

Paget disease causes abnormal bone remodeling with areas of both bone destruction and new bone formation. In the skull, this often shows up as a fine, speckled appearance against a denser background—described as a salt-and-pepper pattern. This pattern results from patchy osteolysis interspersed with sclerosis as the bone turnover is accelerated. Other patterns listed correspond to different processes (sunburst to aggressive periosteal reaction like in osteosarcoma; ground-glass to fibrous dysplasia or hyperparathyroid changes; lytic moth-eaten to various lytic lesions), whereas the salt-and-pepper skull is a classic radiographic hallmark of Paget’s disease.