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Solitary Osseous Lesions of the Spine: Key Features to Guide Management 2014

Category General Spine Aaron Baer, MD Mohannad Ibrahim, MD Colin McKnight, MD Hemant Parmar, MD Purpose The purpose of this educational exhibit is to examine the characteristic imaging features, epidemiology, and clinical presentations of common solitary osseous lesions of the spine. Materials & Methods The following osseous lesions of the spine were compared in terms of their characteristic imaging features, typical anatomic distributions, patient demographics, and clinical presentations: aneurysmal bone cyst, chordoma, enostosis, eosinophilic granuloma, Ewing sarcoma, giant cell tumor, hemangioma, lymphoma, metastases, myeloma, osteoblastoma, osteoid osteoma, osteomyelitis, osteosarcoma, and Paget disease. Patient cases were collected and graphic illustrations were used to demonstrate the unique imaging characteristics of each entity and the similarities among them. Results There are several solitary osseous lesions which have unique imaging features (e.g. hemangioma), patient demographics (e.g. Ewing sarcoma and osteosarcoma), or clinical presentations (e.g. osteoid osteoma) that allow for greater confidence in diagnosis. In contrast, several benign and malignant entities are nonspecific in their location and appearance and require biopsy to ensure proper management. Conclusion There are numerous osseous lesions encountered in the pediatric and adult spine as solitary masses, and these entities are diverse in their clinical presentation and imaging features. With attention to patient age, presentation, and anatomic location, many of these cases can be diagnosed confidently with radiography, CT, or MRI, but it is important to recognize those lesions that require tissue sampling for conclusive diagnosis. References (1) Farsad K, Kattapuram SV, Sacknoff R, et al. Sacral chordoma. Radiographics 2009; 29(5):1525-30. (2) Harrop JS, Schmidt MH, Boriani S, et al. Aggressive "benign" primary spine neoplasms: osteoblastoma, aneurysmal bone cyst, and giant cell tumor. Spine 2009; 34(22):S39-47. (3) Jung HS, Jee WH, McCauley TR, et al. Discrimination of metastatic from acute osteoporotic compression spinal fractures with MR imaging. Radiographics 2003; 23(1):179-87. (4) Rodallec MH, Feydy A, Larousserie F, et al. Diagnostic imaging of solitary tumors of the spine: what to do and say. Radiographics 2008; 28:1019-41.