Differentiation between spinal subchondral bone metastasis with focal pathologic endplate fracture and oedematous Schmorl’s node

Abstract

Introduction:We aimed to identify imaging-based findings that can differentiate between spinal subchondral bone metastasis with focal pathologic endplate fracture and oedematous Schmorl's nodes that have been histopathologically confirmed. Methods: Between March 2010 and April 2016, 11 patients who had undergone spinal magnetic resonance (MR) imaging or computed tomography (CT) with final radiologic reports that included 'subchondral bone metastasis with focal pathologic endplate fracture' or 'edematous Schmorl's node' and had also undergone percutaneous imaging-guided spinal biopsies were included. Two radiologists retrospectively evaluated the following imaging features in consensus: size, location, presence of sclerotic margin, presence of intralesional or perilesional enhancement and opposite endplate enhancement of the involved disc, presence of disc height loss and presence of metabolic uptake at a corresponding lesion on nuclear medicine imaging. Results: A total of 11 patients, including six patients with spinal subchondral bone metastasis with focal pathologic endplate fracture and five patients with oedematous Schmorl's nodes, were included in this study (median age, 58 years; range, 50-63 years; six men). Sclerotic margin (P = 0.002) and enhancement on the opposite endplate of the involved disc (P = 0.047) were significantly different between oedematous Schmorl's node and subchondral bone metastasis with focal pathologic endplate fracture. Conclusion: Sclerotic margin and enhancement on the opposite endplate of the involved disc suggest oedematous Schmorl's node rather than subchondral bone metastasis with focal pathologic endplate fracture. Decreased disc height is likely to be an oedematous Schmorl's node rather than subchondral bone metastasis with focal pathologic endplate fracture.

Imaging Findings of Spinal Metastases with Differential Diagnosis: Focusing on Solitary Spinal Lesion in Older Patients

“…Schmorl’s node는 척추종판의 퇴행성 변화와 연관이 있기 때문에 인접한 척추종판에도 변화가 있는 경우가 흔하고 비교적 경계가 명확한 경화성 테두리로 보인다는 점이 골전이와 감별점이다( 27 29 ). 하지만 한 시점의 영상에서 주변에 신호강도의 변화를 동반한 단일병변으로 발견되었거나 혹은 척추종판에 골절이 동반되는 경우에는 골전이와 감별이 어려워서 조직검사까지 시행하게 되는 경우가 종종 있다( 30 31 ).…”