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Vertebral metastases

Yuranga Weerakkodyand Dr Laughlin Dawes et al.

ertebral metastatic diseasemust be included in any differential diagnosis of a bone lesion in a patient olderan age 40.

pidemiology

ertebral metastases are already present in 10% ofnewly diagnosed cancers. They are much more frequent ingher age groups (> 50 years).

inical presentation

rtebral lesions are very frequently asymptomatic in the setting of widespread metastatic disease, and are thusten found incidentally when imaging is performed for other resons (e.g. staging).

sions may become sympomatic due to bone pain, pathological compression fractures, or extension into spinalnal with cord compression and ensuing neurology.

thology

e most common primary neoplasms to involved the vertebrae include:

breast cancerlung cancerprostatecancerlymphomarenal cell carinomagastrointestinal tract malignanciesmelanoma

etastases are eitehr osteoblastic versus osteolytic, however osteoid formation and mineralisation is of limitedlp in determining theprimary tumour as some metastases may secrete osteoblast- and osteoclast-stimulating

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ctors at the same time. New bone formation may also occur after chemotherapy or radiation therapy. Havingd that some primaries more frequently result in sclerosis than others.

imaries with predominantly osteoblastic metastases (sclerotic extradural bone lesions) include:

prostate carcinomaosteosarcomamedullary thyroid carcinoma

imaries with predominantly osteolytic metastases, that may rarely become osteoblastic (mixed sclerotic and

ic extradural bone lesions)

breast cancerlymphomaurothelial carcinoma

imaries with osteolytic metastases

lung cancergastrointestinal tract cancersrenal cell carcinomamalignant melanomamultiple myeloma

adiographic features

etastatic lesions can have virtually any appearance. They can mimic a benign lesion or an aggressive primaryne tumor. It can be difficult, if not impossible, to judge the origin of the tumor from the appearance of theetastatic focus, although some appearances are fairly characteristic.

ain film

adiographs are useful as an overview but are insensitive to small lytic lesions and struggle to assess formpromise of the canal. As metastases have a predilection for involving the posterior vertebral body anddicle, a missing pedicle (see: absent pedicle sign) is a useful and subtle sign to seek on AP films.

T

e appearance on CT will depend on the degree of mineralisation of the metastasis. The more common lyticetastases appear as regions of soft tissue attenuation with irregular margins. The mass may breach the cortex

d result in compromise of the spinal canal.

lerotic lesions appear hyperdense and irregular but are less likely to extend beyond the vertebrae.

RI

RI is sensitive to metastatic disease and is able also assess for cord compression. The signal intensity of theetastatic deposits will vary according to the degree of mineralisation.

eoblastic metastases

T1: hypo-intenseT2: hypo-intense

xed sclerotic and lytic extradural bone lesions

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T1: hypo-intenseT2: hypo - or / and hyper-intense

ic extradural bone lesions

T1: intermediate to hypo-intenseT2: hyper- or iso-intenseT1 C+ )GD): enhancement usually present

fferential diagnosis

or osteoblastic metastases consider

bone islands (enostoses)spondylosclerosis hemisphericaprimary bone tumours (osteoblastoma, osteoid osteoma)therapy effects (radiation, chemotherapy, vertebroplasty)

mostly solitary lesions, patients may however present with a history of cancer)

rmixed sclerotic and lytic extradural bone lesions consider

primary bone tumoursosteoblastomaosteoid osteoma

therapy effectsradiationchemotherapyvertebroplasty

rlytic extradural bone lesions consider

primary bone tumoursaneurysmal bone cystneurilemmoma/schwannomainfective spondylitisatypical haemangioma

e also

intradural extramedullary metastasesintramedullary metastases

elated articles

ne tumours

e differential diagnosis for bone tumours is dependant on the age of the patient, with a very different set offferentials for the paediatric patient.

bone tumoursbone-forming tumours[+][+]cartilage-forming tumours[+][+]fibrous bone lesions[+][+]bone marrow tumours[+][+]

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other bone tumours or tumour-like lesions[+][+]skeletal metastases

morphology[+][+]location

skull metastasesvertebral metastasesdistal appendicular skeletal metastases

eferences

ynonyms & Alternative Spellings

it Article Share

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rticle Information:

stem:Musculoskeletalction:Pathology

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Case 1Drag here to reorder.

Case 1: lateral radiographDrag here to reorder.

Case 1: MRI T1Drag here to reorder.

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Case 1: MRI T2Drag here to reorder.

Case 2Drag here to reorder.

Case 3Drag here to reorder.

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Case 3 : MRI

Drag here to reorder.

Case 4: with extension into the spinal cordDrag here to reorder.

Case 6: from colon cancer : rareDrag here to reorder.

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Case 5: from renal cell cancerDrag here to reorder.

Case 7: solitary spinous process met from pcaDrag here to reorder.

Case 8: breast cancer mets with pathological fractureDrag here to reorder.

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Case 9Drag here to reorder.

Case 10Drag here to reorder.

Case 11: renal cell carcinomaDrag here to reorder.

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Case 12Drag here to reorder.

Case 13: absent pedicle (winking owl) signDrag here to reorder.

Case 14: from renal cell carcinomaDrag here to reorder.

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SpineUrogenitalVascular

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