J Korean Neurosurg Soc.  2012 Aug;52(2):126-132. 10.3340/jkns.2012.52.2.126.

Imaging Findings of Solitary Spinal Bony Lesions and the Differential Diagnosis of Benign and Malignant Lesions

• Kim YS
• Han IH
• Lee IS
• Lee JS
• Choi BK

• KMID: 2190551
• DOI: http://doi.org/10.3340/jkns.2012.52.2.126

Abstract

OBJECTIVE
The purpose of this study was to present the MRI and CT findings of solitary spinal bone lesions (SSBLs) with the aims of aiding the differential diagnoses of malignant tumors and benign lesions, and proposing a diagnostic strategy for obscure SSBLs.
METHODS
The authors retrospectively reviewed the imaging findings of 19 patients with an obscure SSBL on MRI at our hospital from January 1994 to April 2011. The 19 patients were divided to benign groups and malignant groups according to final diagnosis. MRI and CT findings were evaluated and the results of additional work-up studies were conducted to achieve a differential diagnosis.
RESULTS
At final diagnoses, 10 (52.6%) of the 19 SSBLs were malignant tumors and 9 (47.4%) were benign lesions. The malignant tumors included 6 metastatic cancers, 3 multiple myelomas, and 1 chordoma, and the benign lesions included 4 osteomyelitis, 2 hemangiomas, 2 nonspecific chronic inflammations, and 1 giant cell tumor. No MRI characteristics examined was found to be significantly different in the benign and malignant groups. Reactive sclerotic change was observed by CT in 1 (10.0%) of the 10 malignant lesions and in 7 (77.8%) of the 9 benign lesions (p=0.005).
CONCLUSION
Approximately half of the obscure SSBLs were malignant tumors. CT and MRI findings in combination may aid the differential diagnosis of obscure SSBLs. In particular, sclerotic change on CT images was an important finding implying benign lesion. Finally, we suggest a possible diagnostic strategy for obscure SSBLs on MRI.

Keyword

Solitary spinal bone lesion; Differential diagnosis; MRI; CT; benign lesion; Malignant lesion

MeSH Terms

Chordoma
Diagnosis, Differential
Giant Cell Tumors
Hemangioma
Humans
Inflammation
Multiple Myeloma
Osteomyelitis
Retrospective Studies

Figure

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  Fig. 1 Axial T1-weighted MR images showing SSBLs. A benign lesion involving unilateral pedicle (A) and a malignant lesion involving bilateral pedicles (B).

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  Fig. 2 Sagittal T1-weighted MR image showing vertebral collapse of L5 in the malignant lesion.

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  Fig. 3 Imaging findings of a SSBL diagnosed as nonspecific chronic inflammation (Case 18). Sagittal T1-weighted and axial gadolinium-enhanced MR images show a solitary lesion on T3 (A and B). Axial CT scan shows reactive sclerotic change in the lesion (C).

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  Fig. 4 Diagnostic algorithm for obscure SSBL on MRI.

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