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Diagnostic imaging (Tumors)
Alpaslan Senkoylu, MD
Professor of Orthopaedics and
Traumatology
Istanbul, 25-26 October, 2013
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Outline
• X-ray
• CT Scan
• MRI
• PET Scan
• Angiography
Findings of spinal tumors
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Imaging Modalities of Spinal Tumors
• Malign: Metastatic disease, Myeloma, Lymphoma
• Benign: Hemangioma
• X-ray
• CT Scan
• MRI
• Scintigraphy
• Angiography
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Xray:• Lytic cancellous lesions need 30-50 % destruction for xray-
imaging
• Important for the evaluation of instability and deformity
• Lytic cortical lesions can be detected earlier
• Disc space generally protected in tumors
• “Winking owl” sign for asymmetric pedicular involvement
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Metastatic Lesions
• Lytic
• Lung
• Kidney
• Breast
• Melanoma
• Blastic
• Prostate
• Bladder
• Stomach
• Mixed
• Breast
• Lung
• GI
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CT Scan
Allows visualization of
• Detailed bony anatomy (useful for surgical
planning)
• Extent of soft tissue mass
• Extent and direction of spinal cord impingement by
bone debris
• Special lesions (osteoid osteoma, osteoblastoma..)
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MRI
Superior in evaluating
• Soft tissue mass
• Neural elements
• Multilevel involvement
Findings:
Hipointense T1, Hyperintense T2, Gd-DTPA enhanced T1
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Benign Lesions
• Georaphic bone destruction
• Sclerotic margins
• No soft tissue extension
Except;
Aggressive hemangioma
Eosinophilic granuloma
ABC
Giant-cell tumor
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11 yo, M
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Scintigraphy
• High Sensitivity
• Low specifity
• False Positive:
• Degenerative conditions
• Trauma
• Metabolic bone disease
• False Negative:
• Plasmocytoma
• Myeloma
Useful for the staging!!
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PET Scan
• Important for staging
• Differentiate osteoporotic fracture from pathologic fracture
• SUV less than 3: osteoporotic
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Angiography
• CT or MR angiogram for relationship bw tumor and spinal vessels
• But angiography remains gold standard
• Some vascular tumors may require preop embolization: ABC,
Medullary thyroid CA, giant cell tumor, hemangioma
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Topography
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STIR T2A
T2A T1A precontrast T1A postcontrast
49 yo,M Chordoma
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STIR T2A T1A precontrast T1A postcontrast
T2A T1A postcontrast
55yo, F Atypic Hemangioma
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41 yo F, Chondrosarkoma
T2A T1A postcontrast
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Thank you