What's the Diagnosis? - Case 10

History 53 year old man with history of prostate cancer and nonspecific low back pain.

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Findings Whole body bone scan demonstrates mild increased radiotracer uptake of the L4 vertebral body. MR images demonstrate a coarse, trabecular architecture with a high signal focus on T1, diffuse high signal on T2, and predominantly high signal on IR images but with a focal area of low signal. Axial images further substantiate the paucity of trabeculae but with the residual trabeculae markedly thickened.

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Diagnosis: Hemangioma Osseous hemangioma is a common vascular tumor most frequently encountered in the vertebral body of the lower thoracic or lumbar vertebrae. Imaging findings reflect prominent bony resorption of the majority of the osseous trabeculae with the remaining trabeculae demonstrating a thickened, coarsened architecture frequently referred to as “corduroy” or “polka dot”. Often will be associated with focal areas of fatty signal (high T1, high T2, low IR) and typically show no uptake of radionuclide on bone scan but may demonstrate up to moderate uptake.

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Resources •

www.rsna.org

•

http://emedicine.medscape.com/article/390293-overview

• Ross, Brant-Zawadski, Moore. Diagnostic Imaging: Spine. Amirsys Inc. 2004.

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