The Ivory Vertebra Sign
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Transcript of The Ivory Vertebra Sign
THE IVORY VERTEBRA SIGN
Sudeep Bajracharya
55 yr old female with lower limb weakness Chest x-ray done with the consideration of
Pott’s spine
Case
Dense T5 vertebraNormal Adjacent IVDsNormal paravertebral space
Chest – Normal findings
MRI - Low signal on both T1W and T2W images
Seen in conventional vertebra Increase in opacity of a vertebral body that
retains its size and contours, No change in the opacity and size of
adjacent intervertebral disks Can involve 1 or more vertebras Seen in both adults and children
What is Ivory Vertebra Sign
Osteoblastic metastasis Paget’s disease Hodgkin’s Lymphoma Idiopathic segmental sclerosis Myelosclerosis Fluorosis Osteopetrosis Osteomyelitis
Causes
Sarcoidosis Chordroma Myeloma Ewing’s Sarcoma Osteoid osteoma Osteoblastoma Bone island
Uncommon causes
Sclerosis of the vertebra is rare in children Causes includes
Hodgkin’s Lymphoma Metastatic neuroblastoma Meduloblastoma Few cases of osteogenic sarcoma and Ewing’s
sarcoma
Causes in children
Breast Prostate Osteosarcoma Lung CA Carcinoid tumors Thyroid
stimulate osteoblasts replacement of vertebral body spongiosa with dense and amorphous bony mass
Metastasis from spine usually involves several vertebra
Osteoblastic metastasis
May mimic ivory vertebra Ewing’s sarcoma Osteosarcoma
Primary bone tumors
Characterised by “picture frame” vertebral body
A.k.a “double contour” or “windowed” Overall uniform opacity with sclerosis most
marked at the periphery Relative central lucency is due to atrophy of
the spongiosa Usually causes expansion of the bone due to
trabecular expansion
Paget’s disease
Hodgkin’s Lymphoma Usually both lytic and sclerotic changes are
seen in the vertebra. Purely osteoblastic changes is quite rare If present, sclerosis can be patchy as well as
generalised Paravertebral soft tissue mass is usually
seen along with the affected vertebra
Lymphoma
A.k.a idiopathic segmental sclerosis May be seen in healing vertebral fractures May mimic ivory vertebra
Reactive bone formation
Ivory vertebra with no apparent cause and remains unchanged after interval studies
Mostly attributed to asymptomatic paget’s disease
Affects 30-50 yrs age group Slightly more predominant in women
Idiopathic Ivory vertebra
Few reports of ivory vertebra caused by sarcoidosis and tuberculosis have been reported
OSTEOMYELITIS – may have ivory vertebra in healing stages Usually involves multiple vertebas with erosive
margins
Inflammatory conditions
Non- specific sign With a diverse disease spectrum accounts
for it In adults, primary consideration for ivory
vertebra should be 1. Osteoblastic metastasis 2. Paget’s disease 3. Lymphoma
Conclusion
Thank you