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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