Article Figures & Data
Figures
- Fig 1.
A, Schema of the distribution pattern of a lesion in a single vertebral body. “Diffuse pattern” indicates involvement of the entire region in a single vertebral body; “patchy pattern,” involvement of the partial region in a single vertebral body; and “nodular pattern,” involvement of the nodular area in a single vertebral body. B, Schema of the appearance of homogeneity of a lesion in a single vertebral body. Lesions were considered homogeneous if no evidence of necrosis, cyst, hemorrhage, or fracture was seen on T1- and T2-weighted images. If ≥1 of these features or mixed signal intensity (ie, high and low signal intensity on the MR images) was present, the vertebral lesion was considered heterogeneous.
- Fig 2.
A 54-year-old man with biopsy-proved hyperplastic hematopoietic bone marrow in the T11 vertebral body. Coronal (A) and sagittal (B) reconstructed FDG-PET/CT images reveal the highest uptake (large arrow) in the T11 vertebral body. The SUVmax of the vertebra was 2.4. Subtle uptake is also seen in some thoracic and lumbar vertebral bodies (small arrows). Primary lung cancer is demonstrated in the left lower lung (arrowhead in A). Sagittal T1- (C) and T2-weighted (D) spin-echo MR images of the thoracolumbar spine show diffuse hypointensity (large arrow) in the T11 vertebral body. Patchy hypointense areas are seen in some thoracic and lumbar vertebral bodies (arrowheads). E, Sagittal STIR image of the thoracolumbar spine depicts slight hyperintensity (arrow) in the vertebrae from T10 to L3. F, Sagittal diffusion-weighted image of the thoracolumbar spine reveals marked hyperintense areas (arrowheads) in the vertebrae from T10 to L3. G, The ADC map shows restricted diffusion (arrowheads), corresponding to the hyperintense areas in the vertebrae on diffusion-weighted images. The ADC value in the T11 vertebral body was 0.56 × 10−3mm2/s. H, On the sagittal reconstructed CT image of the thoracolumbar spine, there is diffuse, slightly high attenuation in the T11 vertebral body (large arrow). I, Posterior bone scintigraphy shows no apparent uptake in the thoracolumbar spine.
- Fig 3.
An 84-year-old man with lung cancer and biopsy-proved metastatic bone tumor in the L3 vertebral body. Sagittal T1- (A) and T2-weighted (B) spin-echo MR images of the lumbar spine show diffuse hypointensity (arrow) in the L3 vertebra. There are no vertebral lesions adjacent to the L3 lesion. C, Sagittal STIR image of the lumbar spine depicts hyperintensity (arrow) in the same vertebra. D, On the axial CT image at the level of the L3 lumbar vertebra, there is an osteolytic area in the vertebral body (arrow). E, Axial FDG-PET/CT image at the level of the L3 lumbar vertebra reveals a high uptake area in the vertebral body (arrow). SUVmax of the vertebral lesion was 12.4.
- Fig 4.
Comparison of SUVmax between HHBM and bone metastasis. The SUVmax of the biopsy-proved vertebral lesions is shown. A significant difference is seen between HHBM and bone metastasis (Mann-Whitney test, P = .037). The horizontal short lines indicate 95% CI for the median.
- Fig 5.
Comparison of CT attenuation between HHBM and normal-appearing bone marrow. The mean CT attenuation of HHBM was significantly higher than that of adjacent normal-appearing vertebrae (Wilcoxon signed rank test, P = .0078). The horizontal short lines indicate 95% CI for the median.
- Fig 6.
A proposed diagnostic scheme to be followed by practitioners/radiologists when faced with the problem of differentiating HHBM from bone metastasis. Asterisk indicates that bone biopsy might be still needed in indeterminate cases.
Tables
Case No. Age Sex Clinical Diagnosis (TNM stage) Symptom Location of Spinal Lesions Biopsy Site Brinkman Index Hemoglobin (g/dL) 1 57 Male Lung ca. (T1N0) None T2–L3 T5 684 12.4↓ 2 54 Male Lung ca. (T2N1) None T11–L3 T11 750 11.4↓ 3 59 Male Esop. ca. (T3N2) None C2–T12, S1 T11 780 10.9↓ 4 73 Male Esop. ca. (T1N0) None T9–11 T11 1060 12.6↓ 5 78 Male Esop. ca. (T3N2) None C2–T9, L1,3 L1 0 11.9↓ 6 70 Male Esop. ca. (T2N0) None L3 L3 900 11.6↓ 7 70 Male Lumbar spondylosis LBP C6–T12 T12 1075 14.1 8 52 Male Lumbar spondylosis LBP C9–L5 L3 640 13.7↓ Note:—Lung ca. indicates lung cancer; Esop. ca., esophageal cancer; LBP, low back pain; C, cervical spine; T, thoracic spine; L, lumbar spine; S, sacral spine; ↓, anemia.
T1WI T2WI Distribution Pattern Appearance Hyper Iso Hypo Hyper Iso Hypo Diffuse Patchy Nodular Homo Hetero HHBM (n = 8) 0 0 8 0 0 8 5 2 1 8 0 Metastasis (n = 21) 0 0 21 3 6 12 20 0 1 15 6 Note:—Hyper indicates hyperintensity; Iso, isointensity; Hypo, hypointensity; Homo, homogeneous; Hetero, heterogeneous.
↵a When the signal intensity was divided into 2 categories (hypointensity vs iso- to hyperintensity), there was no significant difference in the T1 signal intensity of the lesions between patients with HHBM and those with bone metastasis. On the other hand, there was a significant difference in the T2 signal intensity of the lesions between the 2 groups (Fisher exact test, P = .033). There was no significant difference in the distribution pattern and appearance of the lesions between patients with HHBM and those with bone metastasis.
CT Appearanceb Grade 1 Grade 2 Grade 3 Grade 4 HHBM (n = 8) 8 0 0 0 Bone metastasis (n = 24) 1 17 5 1 ↵a When the CT appearance was divided into 2 categories (grade 1 vs grades 2–4), HHBM and metastasis differed significantly (Fisher exact test, P < .01).
↵b CT appearance of each vertebral body lesion was classified using the 4-point grading system: grade 1, normal appearance with normal or subtle high attenuation; grade 2, osteolytic lesions; grade 3, osteoblastic lesions; and grade 4, mixed osteolytic and osteoblastic lesions.
