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The authors have studied the sequential events in the process of vertebral metastasis that result in spinal cord compression. Different tumor cell lines were injected into the systemic arterial circulation of syngeneic or nude mice, and they were killed at timed intervals after injection or when they became paraplegic. The following observations were made. The tumor cells lodged and grew in the hematopoietic bone marrow of the vertebrae. Cancer cells in the vertebral marrow cavity invaded into the spinal canal through the foramina of the vertebral veins rather than destroying the cortical bone. Tumor cell lines that grew in an infiltrative fashion migrated toward a posterior location in the spinal canal, and compressed the spinal cord from a posterior direction. Tumor cell lines that grew as compact tumors formed a tumor mass at the same location from which the cells emerged from the vertebra, and compressed the cord predominantly from an anterior direction. Radiographic evidence of vertebral metastasis was a late event, and commonly associated with significant compression of the cord and extraosseous tumor. These experimental findings may help to establish better diagnostic and treatment strategies for patients with metastatic disease of the spine.
The authors have studied the sequential events in the process of vertebral metastasis that result in spinal cord compression. Different tumor cell lines were injected into the systemic arterial circulation of syngeneic or nude mice, and they were killed at timed intervals after injection or when they became paraplegic. The following observations were made. The tumor cells lodged and grew in the hematopoietic bone marrow of the vertebrae. Cancer cells in the vertebral marrow cavity invaded into the spinal canal through the foramina of the vertebral veins rather than destroying the cortical bone. Tumor cell lines that grew in an infiltrative fashion migrated toward a posterior location in the spinal canal, and compressed the spinal cord from a posterior direction. Tumor cell lines that grew as compact tumors formed a tumor mass at the same location from which the cells emerged from the vertebra, and compressed the cord predominantly from an anterior direction. Radiographic evidence of vertebral metastasis was a late event, and commonly associated with significant compression of the cord and extraosseous tumor. These experimental findings may help to establish better diagnostic and treatment strategies for patients with metastatic disease of the spine.
We reviewed spinal MR images of 58 patients with 98 compressed vertebrae. Benign (47 vertebrae) or malignant (51 vertebrae) etiology was established by biopsy or radiologic follow-up. Compressed vertebrae were analyzed for presence and characteristics of signal abnormality, altered vertebral contour, Schmorl's nodes, pedicular involvement, and contrast uptake. Statistical analysis was performed. Diffuse and homogeneous decrease in signal intensity on T1-weighted images, convex vertebral contour, involvement of the pedicles, and a lumbar location were more frequently observed in malignant fractures (P < .01). A thoracic location, lack of signal change, or a band-like abnormality and absence of pedicular involvement or contour abnormality characterized benign fractures (P < .01). Schmorl's nodes and enhancement did not help establish a diagnosis. When a constellation of MR criteria are applied, the accuracy of the diagnosis of malignant and benign vertebral compression fractures may reach 94%.
Malignant mesothelioma has rarely been reported to metastasize to bone. This is a report of a 71-year-old man who presented with pleural mesothelioma. After a course of chemotherapy, the patient developed lower back pain. Plain X-ray and bone scan were negative for metastases, but magnetic resonance imaging (MRI) revealed multiple metastatic lesions to the thoracolumbar vertebrae. Subsequent lumbar spine biopsy confirmed the presence of malignant mesothelioma. The patient then received radiation therapy. This report illustrates an unusual presentation for malignant mesothelioma and shows that, in addition, when bone metastases are clinically suspected, MRI may be a useful adjunct to more conventional imaging approach.
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