Spinal involvement of hematopoietic malignancies and metastasis: differentiation using MR imaging

Radiomics model based on MRI to differentiate spinal multiple myeloma from metastases: A two-center study

Purpose

Spinal multiple myeloma (MM) and metastases are two common cancer types with similar imaging characteristics, for which differential diagnosis is needed to ensure precision therapy. The aim of this study is to establish radiomics models for effective differentiation between them.

Methods

Enrolled in this study were 263 patients from two medical institutions, including 127 with spinal MM and 136 with spinal metastases. Of them, 210 patients from institution I were used as the internal training cohort and 53 patients from Institution II were used as the external validation cohort. Contrast-enhanced T1-weighted imaging (CET1) and T2-weighted imaging (T2WI) sequences were collected and reviewed. Based on the 1037 radiomics features extracted from both CET1 and T2WI images, Logistic Regression (LR), AdaBoost (AB), Support Vector Machines (SVM), Random Forest (RF), and multiple kernel learning based SVM (MKL-SVM) were constructed. Hyper-parameters were tuned by five-fold cross-validation. The diagnostic efficiency among different radiomics models was compared by accuracy (ACC), sensitivity (SEN), specificity (SPE), area under the ROC curve (AUC), YI, positive predictive value (PPV), negative predictive value (NPY), and F1-score.

Results

Based on single-sequence, the RF model outperformed all other models. All models based on T2WI images performed better than those based on CET1. The efficiency of all models was boosted by incorporating CET1 and T2WI sequences, and the MKL-SVM model achieved the best performance with ACC, AUC, and F1-score of 0.862, 0.870, and 0.874, respectively.

Conclusions

The radiomics models constructed based on MRI achieved satisfactory diagnostic performance for differentiation of spinal MM and metastases, demonstrating broad application prospects for individualized diagnosis and treatment.

[Imaging Findings of Spinal Metastases with Differential Diagnosis: Focusing on Solitary Spinal Lesion in Older Patients]

If a solitary spinal lesion is found in an older patient, bone metastasis can be primarily considered as the diagnosis. Bone metastasis can occur anywhere, but it mostly occurs in the vertebral body and may sometimes show typical imaging findings, presenting as a single lesion. Therefore, differentiating it from other lesions that mimic bone metastases can be challenging, potentially leading to delayed diagnosis and initiation of primary cancer treatment. This review provides an overview of imaging findings and clinical guidelines for bone metastases and discusses its differences from other diseases that can occur as solitary spinal lesions in older patients.

Validation of a Diagnostic Model to Differentiate Multiple Myeloma from Bone Metastasis

Purpose

A diagnostic model to differentiate multiple myeloma (MM) from bone metastasis (BM) in patients with destructive bone lesions (MM-BM DDx) was developed to promote timely and appropriate referral of patients with MM to hematologists. External validation has never been conducted. This study aims to externally validate the performance of the MM-BM DDx model.

Patients and Methods

This multi-center external validation study was conducted using retrospective data of patients over 45 years old diagnosed with MM or BM at six university-affiliated hospitals in Thailand from 2016 to 2022. The MM-BM DDx development dataset, including patients from 2012 to 2015, was utilized during external validation. Diagnostic indicators for MM included in the MM-BM DDx model are serum creatinine, serum globulin, and serum alkaline phosphatase (ALP). MM and BM diagnosis was based on the documented International Classification of Diseases 10th Revision codes. Model performance was evaluated in terms of discrimination, calibration, and accuracy.

Results

A total of 3018 patients were included in the validation dataset (586 with MM and 2432 with BM). Clinical characteristics were similar between the validation and development datasets. The MM-BM DDx model's predictions showed an AUC of 0.89 (95% CI, 0.87, 0.90). The predicted probabilities of MM from the model increased concordantly with the observed proportion of MM within the validation dataset. The estimated sensitivity, specificity, and LR for each odds class in the validation dataset were similar to those of the development dataset.

Conclusion

The discriminative ability and calibration of the MM-BM DDx model were found to be preserved during external validation. These findings provide support for the practical use of the MM-BM DDx model to assist clinicians in identifying patients with destructive bone lesions who are likely to have MM and enable them to arrange timely referrals for further evaluation by hematologists.

Comparison of conventional magnetic resonance imaging and diffusion-weighted imaging in the differentiation of bone plasmacytoma from bone metastasis in the extremities

PURPOSE

To compare conventional magnetic resonance imaging (MRI) and diffusion-weighted imaging (DWI) in the differentiation of bone plasmacytoma from bone metastasis in the extremities.

MATERIALS AND METHODS

A total of 65 patients with 27 bone plasmacytomas (11 men; mean age, 63.6±8.2 [SD] years) and 38 patients with bone metastases (20 men; mean age, 64.1±11.5 [SD] years) were retrospectively included. Plasmacytomas and metastases were compared for size, peritumoral edema, signal intensity (SI), SI pattern, apparent diffusion coefficient (ADC) values and standard deviation (SD) of ADC. Receiver operating characteristic analysis with area under the curve (AUC) was used to calculate sensitivity, specificity, and accuracy of MRI and DWI for the diagnosis of plasmacytoma according to a defined cut-off value.

RESULTS

On conventional MRI, plasmacytomas showed less peritumoral edema (22% vs. 71%; P<0.001), were more often hyperintense on T1-weighted image (48% vs. 18%; P=0.022) and more homogeneous on T2-weighted image (78% vs. 26%; P<0.001) and contrast-enhanced T1-weighted images (70% vs. 25%; P=0.001) than bone metastases. Mean ADC value and SD of ADC were significantly lower in bone plasmacytomas (760.1±196.9 [SD] μm²/s and 161.5±62.7 [SD], respectively) than in bone metastases (1214.2±382.6 [SD] μm²/s and 277.0±110.3 [SD], respectively) (P<0.001). Using an ADC value≤908.3μm²/s, DWI yielded 88% sensitivity and 78% specificity for the diagnosis of plasmacytoma. ADC value yielded best area under the curve (AUC=0.913), followed by SD of ADC (AUC=0.814) and homogeneity on T2-weighted images (AUC=0.757). The combination of conventional MRI and DWI (AUC=0.894) showed improved diagnostic performance over conventional MRI alone (AUC= 0.843) for discriminating between plasmacytoma and metastasis.

CONCLUSION

Conventional MRI in combination with DWI can be useful to discriminate between bone plasmacytoma and bone metastasis in the extremities.

Extraosseous spinal epidural plasmocytoma associated with multiple myeloma: Two case reports

BACKGROUND

Multiple myeloma is a malignant hematological disease characterized by proliferation of monoclonal plasma cells mainly in the bone marrow. Extraosseous epidural plasmacytoma associated with myeloma arises from lymphoid tissue in the epidural space without focal vertebral involvement, and is rare.

CASE SUMMARY

A 52-year-old woman was diagnosed with kappa subtype nonsecretory multiple myeloma and presented with bilateral arm weakness 11 mo after completing multiple courses of chemotherapy. Spinal magnetic resonance imaging (MRI) showed a posterior C7–T3 epidural mass with spinal cord compression. After five courses of chemotherapy, follow-up MRI showed resolution of cord compression. A 54-year-old man presented with paraplegia 15 mo after a diagnosis of IgD kappa subtype multiple myeloma and completing multiple courses of chemotherapy. He underwent Th11 and L1 laminectomies for tumor resection because MRI showed an epidural mass causing cord compression. His-topathologic examination was consistent with IgD multiple myeloma. The patients have currently survived for 33 mo and 19 mo, respectively.

CONCLUSION

Isolated extraosseous epidural plasmacytoma associated with multiple myeloma without bony involvement is difficult to diagnose by imaging. Definitive diagnosis requires pathological and immunohistochemical examination.

Differentiating Between Multiple Myeloma and Metastasis Subtypes of Lumbar Vertebra Lesions Using Machine Learning-Based Radiomics

Objective

To determine whether machine learning based on conventional magnetic resonance imaging (MRI) sequences have the potential for the differential diagnosis of multiple myeloma (MM), and different tumor metastasis lesions of the lumbar vertebra.

Methods

We retrospectively enrolled 107 patients newly diagnosed with MM and different metastasis of the lumbar vertebra. In total 60 MM lesions and 118 metastasis lesions were selected for training classifiers (70%) and subsequent validation (30%). Following segmentation, 282 texture features were extracted from both T1WI and T2WI images. Following regression analysis using the least absolute shrinkage and selection operator (LASSO) algorithm, the following machine learning models were selected: Support‐Vector Machine (SVM), K-Nearest Neighbor (KNN), Random Forest (RF), Artificial Neural Networks (ANN), and Naïve Bayes (NB) using 10-fold cross validation, and the performances were evaluated using a confusion matrix. Matthews correlation coefficient (MCC), sensitivity, specificity, and accuracy of the models were also calculated.

Results

To differentiate MM and metastasis, 13 features in the T1WI images and 9 features in the T2WI images were obtained. Among the 10 classifiers, the ANN classifier from the T2WI images achieved the best performance (MCC = 0.605) with accuracy, sensitivity, and specificity of 0.815, 0.879, and 0.790, respectively, in the validation cohort. To differentiate MM and metastasis subtypes, eight features in the T1WI images and seven features in the T2WI images were obtained. Among the 10 classifiers, the ANN classifier from the T2WI images achieved the best performance (MCC = 0.560, 0.412, 0.449), respectively, with accuracy = 0.648; sensitivity 0.714, 0.821, 0.897 and specificity 0.775, 0.600, 0.640 for the MM, lung, and other metastases, respectively, in the validation cohort.

Conclusions

Machine learning–based classifiers showed a satisfactory performance in differentiating MM lesions from those of tumor metastasis. While their value for distinguishing myeloma from different metastasis subtypes was moderate.

Diffusion-Weighted Magnetic Resonance Imaging of Spine

척추영상에 사용되는 확산강조영상의 기술적 측면, 양성과 악성 척추체 압박골절의 구분, 다발성골수종이나 전이암의 발견과 감별진단, 그리고 항암화학요법이나 방사선치료 후 반응 평가에 대해 기술하고자 한다.

Differentiation of spinal metastases originated from lung and other cancers using radiomics and deep learning based on DCE-MRI

PURPOSE

To differentiate metastatic lesions in the spine originated from primary lung cancer and other cancers using radiomics and deep learning, compared to traditional hot-spot ROI analysis.

METHODS

In a retrospective review of clinical spinal MRI database with a dynamic contrast enhanced (DCE) sequence, a total of 61 patients without prior cancer diagnosis and later confirmed to have metastases (30 lung; 31 non-lung cancers) were identified. For hot-spot analysis, a manual ROI was placed to calculate three heuristic parameters from the wash-in, maximum, and wash-out phases in the DCE kinetics. For each case, the 3D tumor mask was generated by using the normalized-cut algorithm. Radiomics analysis was performed to extract histogram and texture features from three DCE parametric maps. Deep learning was performed using these maps as inputs into a conventional convolutional neural network (CNN), as well as using all 12 sets of DCE images into a convolutional long short term memory (CLSTM) network.

RESULTS

For hot-spot ROI analysis, mean wash-out slope was 0.25 ± 10% for lung metastases and -9.8 ± 12.9% for other tumors. CHAID classification using a wash-out slope of -6.6% followed by wash-in enhancement ratio of 98% achieved a diagnostic accuracy of 0.79. Radiomics analysis using features representing tumor heterogeneity only reached the highest accuracy of 0.71. Classification using CNN achieved a mean accuracy of 0.71 ± 0.043, whereas a CLSTM improved accuracy to 0.81 ± 0.034.

CONCLUSIONS

DCE-MRI machine-learning analysis methods have potential to predict lung cancer metastases in the spine, which may be used to guide subsequent workup for confirmed diagnosis.

Differentiation of multiple myeloma and metastases: Use of axial diffusion-weighted MR imaging in addition to standard MR imaging at 3T

Background

Metastasis and multiple myeloma are common malignant bone marrow lesions which may be difficult to distinguish because of similar imaging findings. The purpose of this study was to determine the value of adding diffusion-weighted imaging (DWI) to standard MR imaging to differentiate multiple myeloma from metastasis.

Methods

25 patients with metastasis and 18 patients with multiple myeloma underwent 3T MR imaging with DWI (b = 0, 800 s/mm²) were enrolled. They all had pathologically confirmed bone lesions and were in a treatment naïve state. Two readers who were blind of final diagnosis measured the average ADC (ADCav) and minimum ADC (ADCmin) on the DWI. They then estimated the diagnosis, based on the standard MR imaging and measured ADC values. Another reader performed histogram analysis on the whole tumor volume and obtained mean ADC (ADCvol), standard deviation (SDvol), skewness, and kurtosis. Comparison of the obtained values from DWI was performed by the t-test or Mann-Whitney U test. The receiver operating characteristic (ROC) curve with areas under the curve (AUC) was used to obtain the cut off values and to evaluate the diagnostic performance of the two readers.

Results

ADCav, ADCmin, and ADCvol of multiple myeloma were significantly lower than those of metastasis: ADCav, 752 μm²/sec versus 1081 μm²/sec; ADCmin, 704 μm²/sec vs 835 μm²/sec; ADCvol 761 μm²/sec vs 1184 μm²/sec (p < .001). In histogram analysis, ADC values of multiple myeloma showed narrow distribution than metastasis: SDvol, 144 vs 257 (p < .001). Areas under the receiver operating characteristic curve was significantly higher with additive DWI than standard MR alone: 0.762 vs 0.953; 0.706 vs 0.950 (p < .05) for two readers.

Conclusions

This study suggested that the addition of axial DWI to standard MR imaging can be helpful to diagnose multiple myeloma from metastasis at 3T.

Diagnosis of non-osseous spinal metastatic disease: the role of PET/CT and PET/MRI

The spine is the third most common site for distant metastasis in cancer patients with approximately 70% of patients with metastatic cancer having spinal involvement. Positron emission tomography (PET), combined with computed tomography (CT) or magnetic resonance imaging (MRI), has been deeply integrated in modern clinical oncology as a pivotal component of the diagnostic work-up of patients with cancer. PET is able to diagnose several neoplastic processes before any detectable morphological changes can be identified by anatomic imaging modalities alone. In this review, we discuss the role of PET/CT and PET/MRI in the diagnostic management of non-osseous metastatic disease of the spinal canal. While sometimes subtle, recognizing such disease on FDG PET/CT and PET/MRI imaging done routinely in cancer patients can guide treatment strategies to potentially prevent irreversible neurological damage.

Conventional and Advanced Imaging of Spine Oncologic Disease, Nonoperative Post-treatment Effects, and Unique Spinal Conditions

In this review, we discuss the imaging features of diseases and conditions ranging from neoplastic to nonoperative post-treatment effects to unique conditions of the spine. Additionally, advanced imaging may increase diagnostic certainty in cases where conventional imaging characteristics of benign lesions and malignant pathology are variable.

Neuroradiology of Pediatric Hemolymphoproliferative Disease

Hemolymphoproliferative diseases (HLD) are among the most common causes of morbidity and mortality in children. In the past few years, the increased effectiveness of treatment modalities has significantly increased overall survival, but has also disclosed new aspects of the natural history of these disorders, among which central nervous system (CNS) involvement. CNS complications of HLD can basically be categorized into direct localization of primary disease, indirect effects of malignancy such as cerebrovascular or infectious complications, and iatrogenic side effects. Magnetic resonance imaging plays an important, often crucial role in the diagnosis of several of these disorders. Close interdisciplinary collaboration between hemato-oncologists and neuroradiologists is of paramount importance to provide affected children with an early diagnosis and proper treatment.

Imaging of Spinal Manifestations of Hematological Disorders

Imaging manifestations of hematological diseases and their potential complications are broad, and there may be significant overlap in features of various disease processes. Knowledge of appropriate choice of imaging test, pertinent imaging patterns, and pathophysiology of disease can help the reader increase specificity in the diagnosis and treatment of the patient. Most importantly, we encourage readers of this review to engage their radiologists during the diagnostic, treatment, and management phases of care delivery.

(18)F-FDG PET/CT for Diagnosis of Osteosclerotic and Osteolytic Vertebral Metastatic Lesions: Comparison with Bone Scintigraphy

Study Design

A retrospective study.

Purpose

The aims of this study were to investigate the diagnostic value of ¹⁸F-fluorodeoxyglucose (FDG) positron emission tomography (PET) in PET/computed tomography (CT) in the evaluation of spinal metastatic lesions.

Overview of Literature

Recent studies described limitations regarding how many lesions with abnormal ¹⁸F-FDG PET findings in the bone show corresponding morphologic abnormalities.

Methods

The subjects for this retrospective study were 227 patients with primary malignant tumors, who were suspected of having spinal metastases. They underwent combined whole-body ¹⁸F-FDG PET/CT scanning for evaluation of known neoplasms in the whole spine. ^99mTc-methylene diphosphonate bone scan was performed within 2 weeks following PET/CT examinations. The final diagnosis of spinal metastasis was established by histopathological examination regarding bone biopsy or magnetic resonance imaging (MRI) findings, and follow-up MRI, CT and ¹⁸F-FDG PET for extensively wide lesions with subsequent progression.

Results

From a total of 504 spinal lesions in 227 patients, 224 lesions showed discordant image findings. For 122 metastatic lesions with confirmed diagnosis, the sensitivity/specificity of bone scan and FDG PET were 84%/21% and 89%/76%, respectively. In 102 true-positive metastatic lesions, the bone scan depicted predominantly osteosclerotic changes in 36% and osteolytic changes in 19%. In 109 true-positive lesions of FDG PET, osteolytic changes were depicted predominantly in 38% while osteosclerotic changes were portrayed in 15%.

Conclusions

¹⁸F-FDG PET in PET/CT could be used as a substitute for bone scan in the evaluation of spinal metastasis, especially for patients with spinal osteolytic lesions on CT.

Differentiation of myeloma and metastatic cancer in the spine using dynamic contrast-enhanced MRI

Spinal myeloma and metastatic cancer cause similar symptoms and show similar imaging presentations, thus making them difficult to differentiate. In this study, dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) was performed to differentiate between 9 myelomas and 22 metastatic cancers that present as focal lesions in the spine. The characteristic DCE parameters, including the peak signal enhancement percentage (SE%), the steepest wash-in SE% during the ascending phase and the wash-out SE%, were calculated by normalizing to the precontrast signal intensity. The two-compartmental pharmacokinetic model was used to obtain K(trans) and kep. All nine myelomas showed the wash-out DCE pattern. Of the 22 metastatic cancers, 12 showed wash-out, 7 showed plateau, and 3 showed persistent enhancing patterns. The fraction of cases that showed the wash-out pattern was significantly higher in the myeloma group than the metastatic cancer group (9/9=100% vs. 12/22=55%, P=.03). Compared to the metastatic cancer group, the myeloma group had a higher peak SE% (226%±72% vs. 165%±60%, P=.044), a higher steepest wash-in SE% (169%±51% vs. 111%±41%, P=.01), a higher K(trans) (0.114±0.036 vs. 0.077±0.0281/min, P=.016) and a higher kep (0.88±0.26 vs. 0.49±0.23 1/min, P=.002). The receiver operating characteristic analysis to differentiate between these two groups showed that the area under the curve was 0.798 for K(trans), 0.864 for kep and 0.919 for combined K(trans) and kep. These results show that DCE-MRI may provide additional information for making differential diagnosis to aid in choosing the optimal subsequent procedures or treatments for spinal lesions.

Imaging manifestations of malignant neoplasia mimicking pyogenic osteodiscitis

Malignant neoplasia involving contiguous vertebrae and the corresponding intervertebral discs is a rare occurrence that has similar imaging manifestations as pyogenic osteodiscitis. The authors describe the imaging manifestations of two cases of malignant neoplasia mimicking pyogenic osteodiscitis. We present a case of an 83-year-old male with metastatic non-small cell lung carcinoma and an 82-year-old female with a plasmacytoma, both within the thoracic spine. These cases illustrate how the imaging features of pyogenic osteodiscitis may parallel those of malignant neoplasia.

Isolated extraosseous epidural myeloma presenting with thoracic compressive myelopathy

BACKGROUND CONTEXT

Multiple myeloma is the commonest primary malignancy of the spine, but it rarely presents as an extraosseous epidural tumor with only five cases reported in literature so far.

PURPOSE

The purpose of this study was to heighten awareness and treatment options of a rare case of extraosseous epidural myeloma.

STUDY DESIGN

The study design comprises a case report and literature review.

METHODS

We present a 60-year-old lady with progressive paraplegia (American Spinal Injury Association grade C) with sensory blunting below T8 level of 2 months' duration. Magnetic resonance imaging showed an extradural tumor in the dorsal epidural space from T6 to T7 without local bony involvement. She underwent a T6 and T7 laminectomy, T5-T8 pedicle screw instrumentation, and gross total resection of tumor. Histopathological diagnosis was consistent with myeloma. After surgery, the patient underwent local irradiation and adjuvant chemotherapy.

RESULTS

Neurological improvement of one grade (American Spinal Injury Association grade C to D) was observed at 3 weeks postoperatively.

CONCLUSIONS

Isolated extraosseous epidural myeloma without destruction or collapse of vertebral bodies should be included in the differential diagnosis of epidural mass lesions causing spinal cord compression. The overall prognosis in terms of survival is poor, but early decompression can prevent neurological deterioration and improve quality of life.

[Erosive intervertebral joint lesions. A case of pigmented villonodular synovitis]

Pigmented villonodular synovitis (PVNS) is a rare proliferative lesion that can affect synovial membranes, tendon sheaths, and bursae. It is usually a monarticular disease of the lower extremities, and so far fewer than 30 cases of spinal involvement have been reported in the literature. We describe a patient with progressive lumbar pain and spinal claudication, in whom a CT scan of the lumbar spine revealed destruction fo facet joints L3 to L5. An open biopsy was performed, which led to the diagnosis fo PVNS. The patient underwent successful surgical resection of the tumour mass and stabilization of segments L3 to S1. Two years after surgery the patient has no signs of recurrence. Differential diagnosis of erosive vertebral joint disease is discussed.

Spinal Cord Compression Secondary to Epidural Bilharzioma: Case Report

A case of an epidural granuloma due to Schistosoma mansoni compressing the spinal cord at T7-T9 is presented. The patient, a 35-year-old Brazilian man, started complaining of recurrent back pain since 2003. A magnetic resonance imaging (MRI) scan showed a large epidural mass extending from T7 to T9 and causing mild spinal cord compression. Through a bilateral laminectomy the bilharzioma was subtotally removed without significant bleeding. The histopathology confirmed the diagnosis of granuloma due to S. mansoni. The patient recovered completely. Although the MRI is nonspecific, this differential diagnosis should be included in homogeneous epidural lesions without bone involvement, more than ever in endemic countries or during the evaluation of travelers to those regions.

Extraosseous epidural multiple myeloma presenting with thoracic spine compression

Multiple myeloma is a hematopoetic disorder and multicentric disease, with the most common localisation being the spine. A 47-year-old male presented with progressive paraplegia, superficial and deep sensory disturbance below the level of T4. Spinal magnetic resonance image showed an epidural mass compressing the spinal cord at the level of T4-T6 with intact bone structure. The patient underwent surgical T4-T6 posterior spinal decompression. Microscopic examination and immunohistochemical studies confirmed the diagnosis of multiple myeloma of kappa subtype. Immunoelectrophoresis revealed the presence of immunoglobulin G kappa. The patient was subsequently started on steroids and chemotherapy for myeloma. Extraosseous epidural tumors causing compression myelopathy without evidence of destruction or collapse of vertebral bodies are relatively rare; to our knowledge only four cases have been reported in English literature.

MR Imaging Evaluation of the Bone Marrow and Marrow Infiltrative Disorders of the Lumbar Spine

The use of MR imaging in assessing lumbar bone marrow first requires an understanding of the bone marrow's normal composition and the various imaging sequences available for use. One of the most useful sequences is the T1-weighted spin-echo sequence. This sequence may be combined with other sequences such as T2-weighted or diffusion-weighted sequences; techniques such as fat suppression, chemical shift imaging, and contrast-enhanced imaging are discussed. The varying features of normal lumbar marrow related to the normal physiologic changes that occur with aging and with changes in hematopoietic demand are important to understand and are described. The appearances of infiltrative marrow disease are explained on the basis of marrow composition and whether disease causes proliferation, replacement, or depletion of normal marrow components.

Differential diagnosis of focal and diffuse neoplastic diseases of bone marrow in MRI

Magnetic resonance imaging (MRI) has become the preferred imaging modality for the evaluation of malignant disease in the bone marrow. Compared to bone marrow aspiration and biopsy, MRI is noninvasive and provides information by sampling a large volume of bone marrow. Due to disease-related alterations in the composition of bone marrow, MRI provides a very high sensitivity, but lacks specificity for most bone marrow disorders. However, MRI can be a very valuable diagnostic tool properly placed within the clinical context.

Imaging of the Lumbar Spine Neoplasms

The most common lumbar spine tumors are metastatic disease, myeloma, and hemangioma. Primary osseous lesions of the lumbar spine are unusual. When encountered, they often exhibit characteristic imaging properties, aiding the radiologist to provide a short list of differential diagnoses. We provide a discussion of imaging appearance of lumbar spine neoplasms. Emphasis of this review is on osseous lesions. Few common neurogenic intradural, extraaxial lesions are also discussed.

Magnetic resonance imaging of spinal involvement by hematopoietic malignancies requiring surgical decompression

To elucidate magnetic resonance imaging (MRI) findings of the spine with hematopoietic malignancies that require surgery, we retrospectively reviewed the MRI scans in these patients who underwent decompression surgery of the spinal cord or cauda equina. Preoperative MRI scans were obtained from nine patients with spinal involvement by a hematopoietic malignancy who underwent surgery: four with malignant lymphoma and five with multiple myeloma. The marrow involvement pattern, location of signal change of the vertebra, cortical destruction, vertebral fracture, epidural mass formation, paraspinal mass formation, and the wrap-around sign (spread to the extraosseous soft tissues without alteration in the shape of the affected vertebra) were determined by MRI scans. Diffuse marrow involvement (89%), anterior and posterior signal changes of the vertebra (100%), cortical destruction (100%), vertebral fracture (78%), epidural mass formation (78%), and paraspinal mass formation (100%) were commonly observed. The wrap-around sign was seen in only one patient (11%); it was due to vertebral destruction and deformity. Based on these results, we concluded that MRI findings of the spine with a hematopoietic malignancy requiring decompression surgery showed a characteristic diffuse marrow pattern; they also exhibited more expansive and destructive features than previously reported for hematopoietic malignancies without surgery.

Optimizing patient selection in percutaneous vertebroplasty

Percutaneous vertebroplasty has emerged as an effective technique for treatment of painful vertebral compression fractures (VCFs) caused by osteoporosis, malignancy, and some benign bone tumors. In selecting appropriate patients for vertebroplasty, it is important to distinguish the pain caused by VCF from other numerous causes of back pain. Careful adherence to clinical and imaging selection criteria is crucial to procedural success.

Percutaneous vertebroplasty: A to Z

Percutaneous vertebroplasty has been performed in the United States since 1995, and widespread application of the procedure for osteoporotic and neoplastic compression fractures or vertebral infiltration has demonstrated remarkable efficacy with rare complications. Appropriate patient selection criteria and a thorough understanding of safe technique is essential for clinical success; imaging studies must be combined with careful physical examination to direct treatment to the appropriate level in patients with multiple compression deformities. Preoperative consultation with the patient and their family provides an opportunity to clarify the patient's treatment expectations and helps to anticipate and obviate potential obstacles to treatment.

Evaluation and treatment of spinal metastases: an overview

Metastases to the spine are a common and somber manifestation of systemic neoplasia. The incidence of spinal metastases continues to increase, likely a result of increasing survival times for patients with cancer. Historically, surgery for spinal metastases has consisted of simple decompressive laminectomy. Results obtained in retrospective case series, however, have shown that this treatment provides little benefit to the patient. With the advent of better patient-related selection practices, in conjunction with new surgical techniques and improved postoperative care, the ability of surgical therapy to play an important and beneficial role in the multidisciplinary care of cancer patients with spinal disease has improved significantly. Controversy remains, however, with respect to the relative merits of surgery, radiotherapy, chemotherapy, or a combination of these treatments.

In this topic review, the literature on spinal column and spinal cord metastases is collated to provide a description of the presentation, investigations, indications for surgical therapy, and the role of adjuvant cancer therapies for patients with spinal metastases. In addition, the authors discuss the different surgical strategies available in the armamentarium of the neurosurgeon treating patients with spinal metastasis.