Vertebral and Paravertebral Diseases

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1 Department of Radiology University of California San Diego Vertebral and Paravertebral Diseases John R. Hesselink, M.D.

2 Vertebral / Paravertebral Disease (Extradural) Metastatic disease Primary bone tumors Bone marrow disease Paraspinal tumors Infection

3 History: 72 y/o man with esophageal CA Sag T1 Sag T2 T1-Gd-FS

4 Breast Metastases T1 FSE T2 FSE STIR

5 History: 28 y/o female with back pain & urinary incontinence 569

6 {Page 2}

7 {Page 3} Dx: Lymphoma

8 History: 64 y/o woman with back pain Dx: Diffuse Breast metastases 547

9 History: 62 y/o man with back pain Dx: Diffuse Prostate metastases 548

10 Vertebral Compression Benign vs. Malignant Marrow signal intensity Signal pattern on T1WIs Pedicles & posterior elements Paraspinal mass Enhancement features Diffusion properties

11 Breast Metastases T1 FSE T2 FSE STIR

12 History: 70 y/o woman with back pain 545

13 Dx: Renal cell CA {Page 2}

14 Traumatic Vertebral Fracture 3 Weeks Ago LE 1-2

15 Benign Vertebral Collapse LE 3-5

16 {Page 2}

17 Biopsy negative for tumor {Page 3}

18 Chronic Benign Vertebral Collapse

19 Chronic Vertebral Collapse with a Subacute Endplate Compression

20 Acute Vertebral Fracture T2 FSE T1 FSE STIR

21 Vertebral Body Fracture T2 FSE T1 FSE STIR

22 Spinal Metastases Post Radiation Therapy TD 40

23 History: 62 y/o man with spasms in the mid-back Dx: Vertebral Hemangioma 222

24 History: 55 y/o man with progressive leg weakness for 6 months

25 Dx: Vertebral hemangioma {Page 2}

26 Primary Bone Tumors Osteosarcoma Chondrosarcoma Osteoblastoma Aneurysmal bone cyst Giant cell tumor Osteoid osteoma Eosinophilic granuloma Vascular tumors

27 31 History: 55 y.o. man with leg weakness

28 Dx: Chondrosarcoma Leg weakness {Page 2}

29 Osteoblastoma Jerry Dwek, Rady Children s Hospital of San Diego

30 History: 11 month male

31 {Page 2} Marvin Nelson, Children s Hospital of Los Angeles Dx: Osteochondroma

32 Aneurysmal Bone Cyst Jerry Dwek, Rady Children s Hospital of San Diego

33 Mark Halsted & Elizabeth Ey, Cincinnati Children s Hospital Aneurysmal Bone Cyst

34 {Page 2}

35 Osteoid Osteoma Jerry Dwek, Rady Children s Hospital of San Diego

36 Langerhans Cell Histiocytosis Jerry Dwek, Rady Children s Hospital of San Diego

37 History: 67 y/o man with sacral pain with sitting & kneeling 766 VA7495

38 Dx: Sacral chordoma {Page 2}

39 History: 41 y.o. female with low back and buttock pain 67

40 {Page 2} Dx: Sacral metastasis - Breast carcinoma

41 Bone Marrow Disease Metastatic disease Tumors of blood cell origin Blood dyscrasias / anemias Radiation therapy

42 History: 65 y/o woman with back pain & progressive leg weakness & gait problem for 2 months 656

43 Dx: Plasmacytoma {Page 2}

44 History: 53 y/o woman with back pain & bilateral foot numbness 692

45 Dx: Plasmacytoma & Multiple myeloma {Page 2}

46 History: 32 y/o man with back pain Dx: Epidural lymphoma 557

47 Leukemia Sag T1 Sag T2 FS T1-FS post contrast Evelyne Fliszar, UC San Diego

48 History: 54 y/o woman with CLL & right foot numbess Sag T2 Sag T1 T1-FS post contrast

49 History: 54 y/o woman with chronic lymphocytic leukemia, anemia, & s/p bone marrow transplant Dx: Anemia of chronic disease 714

50 History: 35 y/o man with chronic leg ulcer for 4 months 517

51 Dx: Staph osteomyelitis {Page 2}

52 History: 40 y/o man with worsening back & abdominal pain for 3 weeks 653

53 Dx: TB spine {Page 2}

54 578 History: 50 y/o man with AIDS, hepatitis B & back pain

55 Dx: Staph osteomyelitis & psoas abscesses {Page 2}

56 History: 30 y/o man with neck pain 371

57 {Page 2} Dx: IVDA - Staph osteomyelitis

58 Cocci Osteomyelitis CC 1-2

59 {Page 2}

60 162 History: 23 y/o male IVDA who had an MVA following an overdose

61 {Page 2} Dx: Staph epidural abscess

62 History: 46 y/o woman developed left arm pain and difficulty swallowing 1 week post anterior cervical diskectomy & fusion 595

63 Dx: Retropharyngeal abscess {Page 2}

64 History: 40 y/o male with fever, back pain, and a T6 sensory level 423

65 Dx: Epidural abscess {Page 2}

66 422 History: 73 y/o female with a urinary tract infection and progressive lower extremity weakness and hyperreflexia

67 Dx: Epidural abscess {Page 2}

68 History: 68 y/o woman developed leg weakness following hip surgery 217

69 She also had an epidural catheter for pain control & was on coumadin for deep vein thrombosis {Page 2} Dx: Epidural Hemorrhage (Lab: INA = 3.0)

70 299 History: 16 y/o male with back pain since a fall 2 weeks ago

71 Back pain {Page 2} Dx: Subacute epidural hematoma

72 History: 43 y/o man with chronic progressive morning neck pain 386

73 Dx: OPLL {Page 2}

74 History: 37 y/o man with bilateral leg pain 166

75 {Page 2} Dx: Neurofibromatosis, Type 1

76 History: 69 y/o woman with back pain Dx: Abdominal aortic aneurysm 323

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