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Bone Tumors of the Spine: The Good, The Bad, and The Ugly 2014

Category General Spine Alfred E. Delumpa, MD Janio Szklaruk, PhD MD Pedro Diaz-Marchan, MD Fanny E. Moron, MD Purpose Imaging plays an important role in the detection and diagnosis of spinal bone tumors. Imaging provides information for staging, management, and patient’s prognosis. Computed tomography (CT) and magnetic resonance imaging (MRI) are commonly used in the evaluation of spinal bone tumors. The imaging technique includes a combination of pre-and post-contrast images. Multiple myeloma and metastatic disease are the most common spinal bone tumors, which in practice are readily identified on imaging studies when given the appropriate clinical history. In contrast, primary spinal bone tumors, such as osteosarcoma, are relatively rare and may present a diagnostic challenge. These primary spinal bone tumors may be classified as benign (the good), benign but locally aggressive (the bad), and malignant (the ugly). Unfortunately, in some patients, the imaging features of these tumors may overlap. Thus, to make the correct diagnosis, the radiologist must use a combination of clinical factors such as patient’s age and gender with imaging factors such as tumor location and signal characteristics. In this exhibit we present examples of the imaging features on CT and MR of 11 primary spinal tumors. Furthermore, the exhibit will discuss salient factors in the clinical history, and tumor location that will assist in making the correct diagnosis. The goal of this exhibit is to familiarize radiologists with the imaging appearances, clinical factors, and epidemiology of primary spinal bone tumors. Materials & Methods N/A Results N/A Conclusion Learning points: 1.) Primary spinal bone tumors are much less common than metastatic disease and multiple myeloma. 2.) CT and MRI are complementary in characterizing the tissue make up of primary spinal bone tumors. 3.) Imaging features and tumor location can help distinguish between several primary spinal bone tumors. 4.) Certain primary spinal tumors can be suggested based on vertebral body versus posterior element involvement. 5.) Several primary spinal tumors have almost specific imaging findings. References 1.) Murphey M, et al. From the Archives of the AFIP – Primary Tumors of the Spine: Radiologic-Pathologic Correlation. Radiographics 1996; 16:1131-1158. 2.) Theodorou DJ, et al. An imaging overview of primary tumors of the spine: part 1. Benign tumors. Clinical Imaging 2008; 32: 196-203. 3.) Theodorou D, et al. An imaging overview of primary tumors of the spine: part 2. Malignant tumors. Clinical Imaging 2008; 32: 204-211. 4.) Ropper A, et al. Primary Vertebral Tumors: A Review of Epidemiologic, Histologic, and Imaging Findings, Part I: Benign Tumors. Neurosurgery 2011; 69: 1171-1180. 5.) Ropper A, et al. Primary Vertebral Tumors: A Review of Epidemiologic, Histological and Imaging Findings, Part II: Locally Aggressive and Malignant Tumors. Neurosurgery 2012; 70: 211-219. 6.) Chi J, et al. Epidemiology and Demographics for Primary Vertebral Tumors. Neurosurg Clin N Am 2008; 19: 1-4.