Systematic Approach for Image Interpretation of Spinal Tumors

, Joon Woo Lee1 and Eugene Lee2

(1)
Department of Radiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
(2)
Department of Radiology, Seoul National University Bundang Hospital, Seongnam, South Korea
 
3.1 Intraosseous Tumors
3.1.1 Incidence-Based Approach for Intraosseous Tumors
3.1.2 Age-Based Approach for Intraosseous Tumors
3.1.3 Location-Based Approach for Intraosseous Tumors
3.1.4 Imaging Pattern-Based Approach for IntraosseousTumors
3.2 Extradural Non-osseous Spinal Tumors
3.2.1 Incidence-Based Approach for Extradural Non-osseous Tumors
3.2.2 Imaging Pattern-Based Approach for Extradural Non-osseous Tumors
3.3 Intradural Extramedullary (IDEM) Tumors
3.3.1 Incidence-Based Approach for IDEM Tumors
3.3.2 Age-Based Approach for IDEM Tumors
3.3.3 Location-Based Approach for IDEM Tumors
3.3.4 Imaging Pattern-Based Approach for IDEM Tumors
3.4 Intramedullary (IM) Tumors
3.4.1 Incidence-Based Approach of IM Tumors
3.4.2 Age-Based Approach for IM Tumors
3.4.3 Location-Based Approach for IM Tumors
3.4.4 Imaging Pattern-Based Approach for IM Tumors
3.4.5 IM Tumors Versus Non-tumorous Myelopathy
3.5 Infant/Childhood Spinal Tumors
Bibliography

3.1 Intraosseous Tumors

Intraosseous tumors present as osteolytic or osteoblastic lesions on plain X-ray or CT images. On MRI, intraosseous tumors are best detected on T1-weighted or fat-suppressed T2-weighted images. Diffuse tumor marrow infiltration and involvement (such as may be seen in multiple myeloma) can be missed because of its ill-defined nature. The clue pointing toward diffuse bone marrow involvement is the signal of the bone marrow on T1-weighted images compared with the intervertebral discs; if the signal of the bone marrow is hypointense to intervertebral discs, diffuse marrow infiltrative tumors have to be considered.
In analyzing tumors to arrive at logical differential diagnoses, clinical factors such as patient age and tumor incidence are considered, following which tumor location and imaging pattern are evaluated.

3.1.1 Incidence-Based Approach for Intraosseous Tumors

Most common benign bone tumor
Hemangioma
Most common malignant bone tumor
Metastasis

3.1.2 Age-Based Approach for Intraosseous Tumors

Pediatric (< 20 years)
Eosinophilic granuloma (EG), osteoid osteoma, osteoblastoma, Ewing’s sarcoma, leukemia
Young adult (20–39 years)
Giant cell tumor, osteosarcoma, osteoblastoma, lymphoma
Middle age (40–59 years)
Metastasis, plasmacytoma
Elderly (> 60 years)
Metastasis, multiple myeloma, chondrosarcoma

3.1.3 Location-Based Approach for Intraosseous Tumors

Vertebral body
Giant cell tumor, hemangioma, benign notochordal cell tumors (BNCT), Langerhans cell histiocytosis
Posterior elements
Sarcoma, osteoid osteoma, osteoblastoma
Diffuse
Metastasis, multiple myeloma, lymphoma, leukemia

3.1.4 Imaging Pattern-Based Approach for IntraosseousTumors

Benign appearing osseous lesions
Hemangioma, BNCT, EG, fibrous dysplasia
Radiodense tumor on X-ray
Blastic metastases, osteosarcoma, fibrous dysplasia, BNCT, Hodgkin’s lymphoma, multiple myeloma
Multi-compartmental lesions

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Oct 13, 2017 | Posted by in GENERAL RADIOLOGY | Comments Off on Systematic Approach for Image Interpretation of Spinal Tumors

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