VERTEBRAL METASTASIS



60 yrs female with back pain

Parasagittal T1 wt Image of spine: Homogenous hypointensity involving pedicle, lamina and articular facets with extension into posterosuperior aspect of L2 vertebral body
with well defined anterior margin.



Coronal STIR image: Hyperintensities involving posterior elements of L2 vertebra.

 Axial T1 and T2 wt images: Signal alteration(T1 hypointense and T2 hyperintense) involving postero right lateral aspect of L2 vertabral body and posterior elments with a T2 hypointense anterior margin.

Epidural soft tissue component in the right lateral aspect causing compression of thecal sac.


This patient later proved to have Carcinoma rectum with perirectal lymphnodes which was suspected

  

·        Metastases are the most common vertebral tumors.

·        Osteolytic metastases occur more frequently than osteoblastic metastases.

·        Some metastases have a mixed pattern, with areas of osteolysis and areas of sclerosis.

·        Typically, metastases are multiple and of variable size with cortical disruption (osteolytic lesions).

·        Vertebral compression fracture and epidural tumor are common in metastases.

·        Some slow-growing metastases may mimic a primary bone tumor with mineralization and sclerotic margins.

·        Osteolytic metastases are most often caused by carcinoma of the lung, breast, thyroid, kidney, and colon and (in childhood) neuroblastoma.

·        Osteoblastic metastases are most commonly caused by prostate carcinoma in elderly men and by breast cancer in women.

·        Other osteoblastic metastases are caused by lymphoma, carcinoid tumors, mucinous adenocarcinoma of the gastrointestinal tract, pancreatic adenocarcinoma, bladder carcinoma, neuroblastoma, and (in childhood) medulloblastoma.

Reference : Diagnostic Imaging of Solitary Tumors of the Spine: What to Do and Say, July 2008 RadioGraphics, 28, 1019-1041.