Vertebral hemangioma coincident with metastasis of colon adenocarcinoma

Zapałowicz, Krzysztof; Bierzyńska-Macyszyn, G; Stasiów, Bartłomiej; Krzan, Aleksandra; Wierzycka, Beata; Kopycka, Anna

doi:10.3171/2015.6.spine141205

Cited by 8 publications

(6 citation statements)

References 19 publications

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“…These can be easily mistaken for malignancies and may result in additional diagnostic imaging, biopsy, and in some cases surgery. In addition, atypical VHs have been identified concurrently with metastatic disease from primary malignancy such as colon adenocarcinoma, 15 and thyroid cancer. 16 Consequently, their accurate identification in these cases poses a major challenge associated with a large impact in patient staging and management.…”

Section: Discussionmentioning

confidence: 99%

Differentiating Atypical Hemangiomas and Metastatic Vertebral Lesions: The Role of T1-Weighted Dynamic Contrast-Enhanced MRI

Morales

Arévalo-Pérez²,

Peck

et al. 2018

AJNR Am J Neuroradiol

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Background and Purpose Vertebral hemangiomas are benign vascular lesions that are almost always incidentally found in the spine. Their classic typical hyperintense appearance on T1- and T2-weighted MR images is diagnostic. Unfortunately, not all hemangiomas have the typical appearance and can mimic metastases on routine MRI. These are generally referred to as atypical hemangiomas and can result in misdiagnosis and ultimately to additional imaging, biopsy and unnecessary costs. Our objective is to assess the utility of DCE-MRI perfusion in distinguishing vertebral atypical hemangiomas and malignant vertebral metastases. We hypothesize that permeability and vascular density will be increased in metastases compared to atypical hemangiomas. Materials and Methods Consecutive patients from 2011-2015 with confirmed diagnoses of atypical hemangiomas and spinal metastases from breast and lung carcinoma with available DCE-MRI were analyzed. Time-intensity curves were qualitatively compared among the groups. Perfusion parameters, plasma volume (Vp) and permeability constant (Ktrans), were quantified using an extended Toft’s two-compartment pharmacokinetic model. Statistical significance was tested using Mann-Whitney U test. Results Qualitative inspection of DCE-MRI time-intensity curves demonstrated differences in signal intensity and morphology, between metastases and atypical hemangiomas. Quantitative analysis of Vp and Ktrans perfusion parameters showed a significantly higher values in metastatic lesions when compared to atypical hemangiomas (p<0.001). Conclusions Our data demonstrate that Vp and Ktrans perfusion parameters and qualitative inspection of contrast enhancement curves can be used to differentiate atypical hemangiomas from vertebral metastatic lesions. This works highlights the benefits of adding perfusion maps to conventional sequences that can improve diagnostic accuracy.

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Section: Discussionmentioning

confidence: 99%

Differentiating Atypical Hemangiomas and Metastatic Vertebral Lesions: The Role of T1-Weighted Dynamic Contrast-Enhanced MRI

Morales

Arévalo-Pérez²,

Peck

et al. 2018

AJNR Am J Neuroradiol

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“…The thickened vertical vertebral trabecular pattern is suggestive of VH but is not necessarily conclusive. As illustrated in this case and prior collision tumor cases [ 7 , 8 , 29 , 30 ], there rarely may be underlying malignancy that is only evident with advanced imaging. On MRI, VHs are typically hyperintense on both T1-weighted and T2-weighted images [ 8 ].…”

Section: Discussionmentioning

confidence: 68%

A 68-Year-Old Woman with a Remote History of Breast Cancer Presenting with Low Back Pain to a Chiropractic Clinic in Hong Kong with Imaging Findings Consistent with a Vertebral Hemangioma and Vertebral Metastatic Lesions

Chu¹,

Trager

Chen³

et al. 2022

Am J Case Rep

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Patient: Female, 68-year-old Final Diagnosis: Vertebral metastasis Symptoms: Low back pain Medication:— Clinical Procedure: Magnetic resonance imaging • positron emission tomography-computed tomography Specialty: Chiropractic • Oncology • Radiology Objective: Rare disease Background: Patients commonly visit chiropractic clinics for treatment for low back pain, which is often due to injury or degenerative spinal conditions. Rarely, serious underlying pathology may be identified. This report describes a 68-year-old woman with a remote history of breast cancer presenting with low back pain to a chiropractic clinic in Hong Kong with imaging findings consistent with vertebral hemangioma and vertebral metastatic lesions. Case Report: A 68-year-old woman with a history of breast cancer status after chemotherapy and mastectomy 20 years prior presented to a chiropractor with an acute exacerbation of chronic low back pain with lower extremity pares-thesia. She previously visited her general practitioner and underwent radiography, which supported diagnoses of degenerative lumbar spondylosis and hemangioma of the fifth lumbar vertebra. Given the patient’s worsening status and previous cancer, the chiropractor ordered lumbar magnetic resonance imaging at the initial visit, consistent with multilevel spinal metastasis. The chiropractor referred the patient to an oncologist who performed positron emission tomography/computed tomography, which suggested breast cancer recurrence and metastasis. The greatest hypermetabolic activity was evident within the level of the suspected vertebral hemangioma, suggesting this finding which initially appeared innocuous on plain radiography contained underlying metastasis. Conclusions: This case illustrates that when patients fail to respond to treatment for low back pain, clinical referral should be undertaken for investigations to identify possible serious underlying pathology.

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“…Zerlauth J-B and co-workers 14 reported a Case of a metastatic lesion in the VH from a renal cell carcinoma. Zapałowicz, K and co-workers 15 in his report presented a case of metastasis in a VH from colon adenocarcinoma.…”

Section: Discussionmentioning

confidence: 94%

Spinal collision lesions

Hegde

Azzopardi

Davies

et al. 2021

Journal of Clinical Orthopaedics and Trauma

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Collision lesions are rare neoplasms often described in the hepatobiliary system, genitourinary system and adrenal glands. Vertebral haemangiomas (VH) are the most common lesions involving the vertebral bodies. VHs are usually asymptomatic and considered as "Do not touch" lesions. Rarely they can be symptomatic. Imaging findings of typical and atypical haemangiomas, variant forms of haemangioma such as aggressive haemangiomas are well known. Collision lesions involving VHs are extremely rare. This article presents a series of cases with collision lesions of the vertebral body involving VHs. Advances in knowledge: This Case series demonstrates the various collision lesions in spinal haemangioma.

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Vertebral hemangioma coincident with metastasis of colon adenocarcinoma

Cited by 8 publications

References 19 publications

Differentiating Atypical Hemangiomas and Metastatic Vertebral Lesions: The Role of T1-Weighted Dynamic Contrast-Enhanced MRI

Differentiating Atypical Hemangiomas and Metastatic Vertebral Lesions: The Role of T1-Weighted Dynamic Contrast-Enhanced MRI

A 68-Year-Old Woman with a Remote History of Breast Cancer Presenting with Low Back Pain to a Chiropractic Clinic in Hong Kong with Imaging Findings Consistent with a Vertebral Hemangioma and Vertebral Metastatic Lesions

Spinal collision lesions

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