Department of Radiology University of California San Diego Vertebral and Paravertebral Diseases John R. Hesselink, M.D.
Vertebral / Paravertebral Disease (Extradural) Metastatic disease Primary bone tumors Bone marrow disease Paraspinal tumors Infection
History: 72 y/o man with esophageal CA Sag T1 Sag T2 T1-Gd-FS
Breast Metastases T1 FSE T2 FSE STIR
History: 28 y/o female with back pain & urinary incontinence 569
{Page 2}
{Page 3} Dx: Lymphoma
History: 64 y/o woman with back pain Dx: Diffuse Breast metastases 547
History: 62 y/o man with back pain Dx: Diffuse Prostate metastases 548
Vertebral Compression Benign vs. Malignant Marrow signal intensity Signal pattern on T1WIs Pedicles & posterior elements Paraspinal mass Enhancement features Diffusion properties
Breast Metastases T1 FSE T2 FSE STIR
History: 70 y/o woman with back pain 545
Dx: Renal cell CA {Page 2}
Traumatic Vertebral Fracture 3 Weeks Ago LE 1-2
Benign Vertebral Collapse LE 3-5
{Page 2}
Biopsy negative for tumor {Page 3}
Chronic Benign Vertebral Collapse
Chronic Vertebral Collapse with a Subacute Endplate Compression
Acute Vertebral Fracture T2 FSE T1 FSE STIR
Vertebral Body Fracture T2 FSE T1 FSE STIR
Spinal Metastases Post Radiation Therapy TD 40
History: 62 y/o man with spasms in the mid-back Dx: Vertebral Hemangioma 222
662-2176511 History: 55 y/o man with progressive leg weakness for 6 months
Dx: Vertebral hemangioma {Page 2}
Primary Bone Tumors Osteosarcoma Chondrosarcoma Osteoblastoma Aneurysmal bone cyst Giant cell tumor Osteoid osteoma Eosinophilic granuloma Vascular tumors
31 History: 55 y.o. man with leg weakness
Dx: Chondrosarcoma Leg weakness {Page 2}
Osteoblastoma Jerry Dwek, Rady Children s Hospital of San Diego
History: 11 month male
{Page 2} Marvin Nelson, Children s Hospital of Los Angeles Dx: Osteochondroma
Aneurysmal Bone Cyst Jerry Dwek, Rady Children s Hospital of San Diego
Mark Halsted & Elizabeth Ey, Cincinnati Children s Hospital Aneurysmal Bone Cyst
{Page 2}
Osteoid Osteoma Jerry Dwek, Rady Children s Hospital of San Diego
Langerhans Cell Histiocytosis Jerry Dwek, Rady Children s Hospital of San Diego
History: 67 y/o man with sacral pain with sitting & kneeling 766 VA7495
Dx: Sacral chordoma {Page 2}
History: 41 y.o. female with low back and buttock pain 67
{Page 2} Dx: Sacral metastasis - Breast carcinoma
Bone Marrow Disease Metastatic disease Tumors of blood cell origin Blood dyscrasias / anemias Radiation therapy
History: 65 y/o woman with back pain & progressive leg weakness & gait problem for 2 months 656
Dx: Plasmacytoma {Page 2}
History: 53 y/o woman with back pain & bilateral foot numbness 692
Dx: Plasmacytoma & Multiple myeloma {Page 2}
History: 32 y/o man with back pain Dx: Epidural lymphoma 557
Leukemia Sag T1 Sag T2 FS T1-FS post contrast Evelyne Fliszar, UC San Diego
History: 54 y/o woman with CLL & right foot numbess Sag T2 Sag T1 T1-FS post contrast 773-19113240
History: 54 y/o woman with chronic lymphocytic leukemia, anemia, & s/p bone marrow transplant Dx: Anemia of chronic disease 714
History: 35 y/o man with chronic leg ulcer for 4 months 517
Dx: Staph osteomyelitis {Page 2}
History: 40 y/o man with worsening back & abdominal pain for 3 weeks 653
Dx: TB spine {Page 2}
578 History: 50 y/o man with AIDS, hepatitis B & back pain
Dx: Staph osteomyelitis & psoas abscesses {Page 2}
History: 30 y/o man with neck pain 371
{Page 2} Dx: IVDA - Staph osteomyelitis
Cocci Osteomyelitis CC 1-2
{Page 2}
162 History: 23 y/o male IVDA who had an MVA following an overdose
{Page 2} Dx: Staph epidural abscess
History: 46 y/o woman developed left arm pain and difficulty swallowing 1 week post anterior cervical diskectomy & fusion 595
Dx: Retropharyngeal abscess {Page 2}
History: 40 y/o male with fever, back pain, and a T6 sensory level 423
Dx: Epidural abscess {Page 2}
422 History: 73 y/o female with a urinary tract infection and progressive lower extremity weakness and hyperreflexia
Dx: Epidural abscess {Page 2}
History: 68 y/o woman developed leg weakness following hip surgery 217
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)
299 History: 16 y/o male with back pain since a fall 2 weeks ago
Back pain {Page 2} Dx: Subacute epidural hematoma
History: 43 y/o man with chronic progressive morning neck pain 386
Dx: OPLL {Page 2}
History: 37 y/o man with bilateral leg pain 166
{Page 2} Dx: Neurofibromatosis, Type 1
History: 69 y/o woman with back pain Dx: Abdominal aortic aneurysm 323