This case illustrates the radiological findings of an aneurysmal bone cyst with the typical MRI fluid-fluid levels and septations separating the cysts. 17, no. Vertebral pneumatocysts are gas-filled cavities within the spinal vertebrae. Our patient was a young teenager who practices sports and her daily physical demands augmented the risk of fracture and collapse of the vertebra. MRI has the highest sensitivity for infiltration of the marrow by myeloma cells before cortical destruction occurs. M. Zenmyo, S. Komiya, T. Hamada, and A. Inoue, A solitary bone cyst in the spinous process of the cervical spine: A case report, Spine, vol. 5, MR in-phase/opposed-phase imaging may be very helpful to confirm focal red marrow as a drop in signal on the out-of-phase images by more than 20% is due to the presence of both water and fat signal within the lesion, which suggests a benign lesion as most tumors, with myeloma being the exception, completely displace normal marrow fat. aneurysmal bone cyst; osteoblastoma; hypoplastic/aplastic pedicle; . A lumbar spine X-ray is a picture of the vertebrae in the lower part of the spine. Kransdorf M & Sweet D. Aneurysmal Bone Cyst: Concept, Controversy, Clinical Presentation, and Imaging. Adam Greenspan, Gernot Jundt, Wolfgang Remagen. Signal suppresses completely on fat-suppressed sequences. A complete blood count, urinalysis, basic serum chemistries, as well as serum-free light chains, serum, and urine protein electrophoresis to evaluate for the possibility of multiple myeloma should be performed. Even in patients with a known primary malignancy, however, the diagnosis is not certain from imaging alone as it has been found that a solitary bone lesion has a 12% chance of being either benign or due to metastatic disease with a different histopathology than the known primary. Conclusion: Findings are suggestive of an aneurysmal bone cyst. Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. Location of the lesion, whether centered in the vertebral body versus the posterior elements, may provide guidance as to the most likely diagnosis: Intervertebral degenerative disk disease related or Schmorls node. Summary of 2 new cases and 21 reported cases of bone cyst of lumbar vertebral body. Unicameral bone cyst on bone scintigraphy tends to appear as foci of photopenia (cold spot). 252260, 2006. Normal red marrow on DCE (dynamic contrast-enhanced) MRI time intensity curves (TICs) shows a slow wash-in, low maximal peak, and either minimal or no apparent washout. SBC accounts for the 'S' in the popular mnemonic for lucent bone lesions FEGNOMASHIC. MR signal characteristics for an uncomplicated lesion include 8,10: Fluid-fluid levelscan be seen in the setting of fibrous septations, which can enhance 8. AJR Am J Roentgenol. show answer. Confirmation with CT revealing typical, coarsened trabecula is diagnostic. Physical examination was unremarkable except for tenderness over the lower thoracic spine. ADVERTISEMENT: Supporters see fewer/no ads. 6, no. Soft Tissue and Bone Tumours. They are most common at cervical levels. Radiographs demonstrate a sharply defined, expansile solitary lucent bone lesion, with thin-walled cavities 3. The evaluation of a solitary bony lesion in the spine may be more challenging and will often require additional diagnostic testing if benign imaging features are not present on MRI. Check for errors and try again. (2014) ISBN: 9781907816222 -. Although they have been described in most bones, the most common locations are 3-5: typically eccentrically located in the metaphysis, especially femur, proximal tibia and fibula, and humerus, especially posterior elements of the spine with extension into the vertebral body in 40% of cases 5, short bones of hands and feet: more often with a central location, craniofacial: jaw, basisphenoid, and paranasal sinuses, epiphysis, epiphyseal equivalent,or apophysis: rare but important. The main differential includes both lesions with intrinsic fluid-fluid levels (see fluid-fluid level containing bone lesions) and those from which an aneurysmal bone cyst may arise: osteosarcoma: especially telangiectatic osteosarcoma. Michael A. Blake, Mannudeep K. Kalra. In children it has been suggested that developmental defects in the epiphyseal plate can originate these tumors, but in this case the unusual location of the cyst points towards ruling out this etiology. At the time the article was created Frank Gaillard had no recorded disclosures. The diagnosis of spinal SBC may be difficult and delayed until operative treatment when it is confirmed by histological assessment. The evaluation of a solitary bony lesion in the spine may be more challenging and will often require additional diagnostic testing if benign imaging features are not present on MRI. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide, This PDF is available to Subscribers Only. These benign tumors are common in long bone metaphysis like the proximal humerus, femur, and tibia [4, 6, 10]. Cervical curettage followed by tumor excision was performed. (2008) ISBN: 9783131354211 -, 16. Histological examination supported the diagnosis of simple bone cyst. Check for errors and try again. 105, no. To the best of our knowledge, 21 cases of SBCs affecting the vertebra have been reported in the English literature. A. Sebaaly, B. Ghostine, G. Kreichati et al., Aneurysmal bone cyst of the cervical spine in children: a review and a focus on available treatment options, Journal of Pediatric Orthopaedics, vol. Treatment is not always required and discal cysts have been reported to spontaneously regress 1. On fat-suppressed T2WIs, it is iso- to slightly hyperintense relative to skeletal muscle but should not be extremely bright. Unicameral bone cyst. A 13-year-old female was admitted to hospital for acute demyelinating polyneuropathy confirmed by electromyography and nerve conduction studies; later on a diagnosis of Guillain Barr Syndrome was confirmed. Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. Patient underwent cervical curettage followed by tumor excision. show answer. Compared to the other lesions in this list, aneurysmal bone cysts are markedly expansile (hence, "aneurysmal") and have a thin cortical shell. Epidemiology Spine J. 1981;136(6):1231-2. Identification of an end plate defect adjacent to the area of marrow signal abnormality is helpful in making this diagnosis. 13. They sometimes expand the bone with thinning of the endosteum without any breach of the cortex unless there is a pathologic fracture. A focal, well-defined lesion in the vertebrae that has increased signal on both the T1 W and T2WIs is considered to most likely be a benign hemangioma and no further workup or follow-up imaging is needed. Mauricio Castillo. Patients should discuss the options with their spine surgeon for guidance on whats most likely to provide lasting relief. Lichtenstein L. Aneurysmal bone cyst: A pathologic entity commonly mistaken for giant cell tumour and occasionally for hemangioma and osteogenic sarcoma. View Antonio Rodrigues de Aguiar Neto's current disclosures, see full revision history and disclosures. Neuroradiology Companion. MRI of the Spine. At present, there is no gold standard for treatment for SBCs and Surgery may not be the optimal treatment for patients except for large lesions or pathologic fracture [21]. A 30-year-old woman presented with lower back pain at the L5S1 level for which an LS spine MRI was performed. Become a Gold Supporter and see no third-party ads. Although they are benign, aneurysmal bone cysts can display different clinical natural courses: quiescent, active or aggressive. Simple bone cyst (SBC) is not a common lesion in the spine and especially in the vertebral body. Patients may present with pain, paresthesias, paraplegia, motor deficits, sphincter impairment, and myelopathy. Case 1, (A): Axial T2-weighted MR image of twelfth thoracic spine vertebrae; (B): Sagittal T2-weightedimages of thoracic spine vertebrae. Interventional Radiology). Both lesions were found to be SBC and confirmed by pathology. A complementary MRI performed as part of in-hospital management showed an incidental finding of a cystic lesion in the vertebral body of C2 (Figure 1). 1. As the lesion becomes inactive it migrates away from the growth plate (normal bone is formed between it and the growth plate) and it gradually resolves 3,5. (a), (b), and (c) CT Lesion with cystic appearance, defined borders compromising two-thirds of body C2, in close proximity to the right vertebral artery. Considered the best method of diagnosis. 2). Aneurysmal bone cysts do not express H3.3pGly34Trp, a feature that can be used to differentiate them from giant cell tumors of bone with aneurysmal bone cyst-like changes 1. Table 1 gives a summary of previously reported SBCs of the vertebral column in English literature [626]. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. Chang C, Garner H, Ahlawat S et al. If fractured the bone usually heals normally 5. Studies concluded it was a tumoral lesion with benign characteristics. Unicameral bone cysts (UBC),also known as simple bone cysts (SBC) are common benign non-neoplastic lucent bony lesions that are seen mainly in childhood and typically remain asymptomatic. Typically found in the watershed zone of vertebral body that has been described as predominantly in the anterior half or in multiple areas near the end plate and/or deep medullary portion of the vertebral body involving several levels. 2. Check for errors and try again. No discrete lesion is typically seen on CT. J Am Acad Orthop Surg. 1 When the vertebral lesion has no benign features, especially in the older adult patient, metastatic disease is always a significant consideration. Search for other works by this author on: University of Shahid Beheshti Medical Sciences. They're carried out in hospital by specially trained operators called radiographers, and can be done while you're staying in hospital or during . 2020. In order of frequency, eosinophilic granulomas present in 1225% of cases and osteoid osteoma/osteoblastoma in 12% and aneurysmal bone cysts represent a 10% of the cases [2, 3]. Topouchian V, Mazda K, Hamze B, Laredo J, Penneot G. Aneurysmal Bone Cysts in Children: Complications of Fibrosing Agent Injection. We will then present a more generalized approach to any solitary, incidentally detected bone lesion on MRI. 260272, 2014. What are the symptoms of spinal cysts? These imaging patterns were not consistent with the imaging findings in our patient. 25, no. Hypointense lesions on T1WIs that are hyperintense on the fat-suppressed T2WIs are indeterminate on MRI and often need further evaluation. A: Histological features of aneurysmal bone cysts usually show blood-filled spaces without endothelial lining between fibrous stromata. Haaga, John R. 1945-. 4. Alanazi O, Alshebromi A, Albaz A, Bassi M. Thoracic Spine Aneurysmal Bone Cyst Causing Paraplegia in a Child: A Case Report. This is referred to as the doughnut signwhich results in increased uptake peripherally and a photopenic center. Spontaneous regression may occur rarely or also following partial removal 3,13. (c) An image corresponding to postoperative sagittal CT. Melanin has increased signal on noncontrast T1WIs. Detection of associated intradiscal gas and communication between the vertebral and intradiscal gas can be demonstrated. 7. Percutaneous treatment with fibrosing agents has also been performed, either in isolation or as a precursor to surgical excision 3,11,12. CT scan. 1. 2005;23(27):6756-62. Ogata et al. Caro P, Mandell G, Stanton R. Aneurysmal Bone Cyst of the Spine in Children. Linear area of decreased signal on T1 W and T2WIs associated with degenerative intervertebral disk disease. Veena Chowdhury, Arun Kumar Gupta, Niranjan Khandelwal. Bone island (enostosis). 18. Abbreviations: DWI, diffusion-weighted imaging; FDG, fluorodeoxyglucose; FOV, field of view; GI, gastrointestinal; SPECT, single-photon emission computed tomography; TNM, tumor size, node involvement, and metastasis status; WB-MRI, whole body MRI. Lumbar X-ray showed mild height loss and fracture of the superior endplate of T12 vertebra (Fig. Features on CT are similar to plain radiographs but CT has the advantage of characterizing extent, detecting radiograph-occult fractures, and assessing internal density (usually between 10-15 HU) 8. The most common lesions are as follows: Modic type III (fibrosis) degenerative change. Thieme Medical Pub. The most common benign bone tumor consisting of both vascular and fatty elements the ratio of which determines its signal characteristics. The tumor has a heterogeneous appearance on both T1 and T2-weighted MR, with focal areas of high T1 signal, presumably representing blood. The vast majority of malignant lesions in the adult spine are due to metastatic disease and multiple myeloma/plasmacytoma rather than primary bone tumors, which are rare. If large and threatening to fracture, or causing deformity then an intralesional steroid injection can be performed 3-5. Aneurysmal bone cysts (ABC) are benign expansile osteoclastic giant cell-rich bony neoplasms, composed of numerous blood-filled channels and cystic spaces 1. 9. Scaglietti O, Marchetti PG, Bartolozzi P. Oxford University Press is a department of the University of Oxford. ADVERTISEMENT: Supporters see fewer/no ads. The etiology and pathogenesis are unknown 8,10. Vertebral pneumatocysts: uncommon lesions with pathognomonic imaging characteristics. (2011) ISBN:1609139437. Magnetic resonance imaging (MRI) revealed a well-defined lesion with low signal intensity on T1 and high signal intensity on T2 weighted images (Fig. The differential diagnosis for bone tumors is dependent on the age of the patient, with a very different set of differentials for the pediatric patient. They are typically intramedullary and active cysts are found in the metaphysis of long bones, abutting the growth plate 1. Therefore, a chest, abdomen, and pelvis CT scan is the superior test to evaluate the kidneys and provide TNM staging. If plasmacytoma/multiple myeloma is suspected (i.e., urine protein electrophoresis [UPEP] or serum protein electrophoresis [SPEP] positive, or hypercalcemia, anemia, or renal failure in the older adult), then whole body MRI (WB-MRI) is recommended.
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