Imaging Features of Aggressive Giant Cell Tumors of the Mobile Spine: Retrospective Analysis of 101 Patients From Single Center

Abstract

Study Design: Retrospective study. Objectives: Giant cell tumors (GCTs) of the mobile spine can be locally aggressive. This study described and classified the typical and atypical appearance of aggressive spinal GCTs according to imaging findings to help the imaging diagnosis, especially for patients with rapid neurological deficit that may require emergent surgery without biopsy. Methods: Computed tomography (CT) and magnetic resonance imaging (MRI) scans of patients diagnosed with aggressive spinal GCTs at single center were reviewed. Results: Overall, 101 patients with 100 CT images and 94 MR images were examined. All lesions were osteolytic with cortical destruction; 95 lesions showed epidural extension; 90 were centered in the vertebral body; 82 showed pathological fracture and/or collapse of the vertebral body; 78 had pseudotrabeculation on CT; 80 showed low-to-iso signal intensity or heterogeneous high-signal intensity with cystic areas on the T2-weighted images; 9 showed fluid–fluid level on T2-weighted images; and 61 patients showed marked enhancement on contrast-enhanced CT and/or MRI. Forty-one lesions (40.6%) had at least 1 atypical radiographic feature: 19 involved ≥2 segments; 11 were centered in the posterior neural arch; 10 had a paravertebral mass over 2 segments; 16 showed partial margin sclerosis with partial cortical destruction on CT scans; and 3 showed mineralization within the tumor on CT. Eighty-eight patients underwent CT-guided biopsy with a diagnostic accuracy rate of 94.3%. Conclusions: Spinal GCTs might appear more radiologically atypical, and about 40% of the lesions may have at least 1 atypical feature. CT-guided biopsies are recommended for definitive diagnosis.

Giant cell tumor of bone with secondary aneurysmal bone cyst does not have a higher risk of local recurrence

“…FFLs have been found in 10%-16% of GCTBs. 23,24 The presence of FFLs is suspicious for secondary ABC. 21 Secondary ABC may be associated with increased intraoperative bleeding, making curettage of GCTB more difficult and thus the risk of local recurrence higher.…”

“…GCTB is a locally aggressive bone tumor with a high local recurrence rate. FFLs have been found in 10%–16% of GCTBs 23,24 . The presence of FFLs is suspicious for secondary ABC 21 .…”

“…FFLs within bone lesions were first described as a CT feature of ABCs by Hudson et al 18 Davies et al identified FFLs in 21 of 25 patients with primary ABC and reported a sensitivity of 87.5%, specificity of 99.7%, and positive predictive value of 87.5% for FFLs to diagnose primary ABC 21 . FFLs were found in 9.6%–16.2% of GCTB 23,24 . If it is known before surgery whether or not GCTB is associated with secondary ABC, it is of great clinical value because it is possible to predict the increase in intraoperative bleeding and the risk of local recurrence.…”

“…21 FFLs were found in 9.6%-16.2% of GCTB. 23,24 If it is known before surgery whether or not GCTB is associated with secondary ABC, it is of great clinical value because it is possible to predict the increase in intraoperative bleeding and the risk of local recurrence.…”

Clinical Significance of Preoperative CT and MR Imaging Findings in the Prediction of Postoperative Recurrence of Spinal Giant Cell Tumor of Bone

“…Previous studies suggested that spinal GCTB might appear more radiologically atypical, and about 40% of the lesions may have at least one atypical feature. However, this study did not focus on postoperative recurrence 32 . Our study found that the lesions with compression fractures have higher risks of postoperative recurrence.…”