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Diagnostic Imaging of Solitary Tumors of the Spine: What to Do and Say¹

¹ From the Department of Radiology, Fondation Hôpital Saint-Joseph, 185 rue Raymond Losserand, 75674 Paris 14, France (M.H.R., M.Z.); and Departments of Radiology B (A.F., R.C., J.L.D.), Pathology (F.L.), and Orthopedics B (P.A., A.B.), Hôpital Cochin, Paris, France. Recipient of a Certificate of Merit award for an education exhibit at the 2005 RSNA Annual Meeting. Received July 11, 2007; revision requested August 9 and received October 9; accepted October 23. All authors have no financial relationships to disclose. Address correspondence to M.H.R. (e-mail: mathieurodallec{at}hotmail.com).

Metastatic disease, myeloma, and lymphoma are the most common malignant spinal tumors. Hemangioma is the most common benign tumor of the spine. Other primary osseous lesions of the spine are more unusual but may exhibit characteristic imaging features that can help the radiologist develop a differential diagnosis. Radiologic evaluation of a patient who presents with osseous vertebral lesions often includes radiography, computed tomography (CT), and magnetic resonance (MR) imaging. Because of the complex anatomy of the vertebrae, CT is more useful than conventional radiography for evaluating lesion location and analyzing bone destruction and condensation. The diagnosis of spinal tumors is based on patient age, topographic features of the tumor, and lesion pattern as seen at CT and MR imaging. A systematic approach is useful for recognizing tumors of the spine with characteristic features such as bone island, osteoid osteoma, osteochondroma, chondrosarcoma, vertebral angioma, and aneurysmal bone cyst. In the remaining cases, the differential diagnosis may include other primary spinal tumors, vertebral metastases and major nontumoral lesions simulating a vertebral tumor, Paget disease, spondylitis, echinococcal infection, and aseptic osteitis. In many cases, vertebral biopsy is warranted to guide treatment.

© RSNA, 2008