Vertebral and

Paravertebral Diseases

John R. Hesselink, M.D.

Department of Radiology

University of California

San Diego

Vertebral / Paravertebral Disease

Metastatic disease

Primary bone tumors

Bone marrow disease

Paraspinal tumors

Infection

(Extradural)

History: 72 y/o man with esophageal CA

Sag T1 Sag T2 T1-Gd-FS

Breast Metastases

T1 FSE STIR T2 FSE

History: 28 y/o female with back

pain & urinary incontinence

569

{Page 2}

Dx: Lymphoma

{Page 3}

Dx: Diffuse Breast metastases

History: 64 y/o woman with back pain

547

Dx: Diffuse Prostate metastases

History: 62 y/o man with back pain

548

Vertebral Compression

Marrow signal intensity

Signal pattern on T1WIs

Pedicles & posterior elements

Paraspinal mass

Enhancement features

Diffusion properties

Benign vs. Malignant

Breast Metastases

T1 FSE STIR T2 FSE

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

Dx: Vertebral Hemangioma 222

History: 62 y/o man with spasms

in the mid-back

History: 55 y/o man with progressive

leg weakness for 6 months

662 - 2176511

Dx: Vertebral hemangioma

{Page 2}

Primary Bone Tumors

Osteosarcoma

Chondrosarcoma

Osteoblastoma

Aneurysmal bone cyst

Giant cell tumor

Osteoid osteoma

Eosinophilic granuloma

Vascular tumors

History: 55 y.o. man

with leg weakness

31

Dx: Chondrosarcoma

Leg weakness

{Page 2}

Jerry Dwek, Rady Children’s Hospital of San Diego

Osteoblastoma

History: 11 month male

Dx: Osteochondroma Marvin Nelson, Children’s Hospital of Los Angeles

{Page 2}

Jerry Dwek, Rady Children’s Hospital of San Diego

Aneurysmal Bone Cyst

Aneurysmal Bone Cyst

Mark Halsted & Elizabeth Ey, Cincinnati Children’s Hospital

{Page 2}

Jerry Dwek, Rady Children’s Hospital of San Diego

Osteoid Osteoma

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

Dx: Sacral metastasis -

Breast carcinoma

{Page 2}

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}

Dx: Epidural lymphoma

History: 32 y/o man with back pain

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

773 - 19113240

Sag T2

Sag T1

T1-FS post contrast

Dx: Anemia of chronic disease

History: 54 y/o woman with chronic lymphocytic

leukemia, anemia, & s/p bone marrow transplant

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}

History: 50 y/o man with AIDS,

hepatitis B & back pain

578

Dx: Staph osteomyelitis

& psoas abscesses

{Page 2}

History: 30 y/o man with neck pain

371

Dx: IVDA - Staph osteomyelitis

{Page 2}

Cocci Osteomyelitis

CC 1-2

{Page 2}

History: 23 y/o male IVDA who had

an MVA following an overdose

162

Dx: Staph epidural abscess

{Page 2}

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}

217

History: 68 y/o woman developed leg

weakness following hip surgery

Dx: Epidural Hemorrhage

(Lab: INA = 3.0)

She also had an epidural catheter

for pain control & was on coumadin

for deep vein thrombosis

{Page 2}

History: 16 y/o male with back pain

since a fall 2 weeks ago

299

Dx: Subacute epidural

hematoma

Back pain

{Page 2}

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

Dx: Neurofibromatosis, Type 1

{Page 2}

Dx: Abdominal aortic aneurysm

History: 69 y/o woman with back pain

323