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Factors Influencing Visualization of Vertebral Metastases on MR Imaging Versus Bone Scintigraphy

¹ All authors: Department of Radiology, Magnetic Resonance Imaging Center, University of Iowa College of Medicine, 200 Hawkins Dr., Iowa City, IA 52242.

View larger version (31K): [in a new window]   Fig. 1. —Graph of correlation of positive bone scan with lesion location and size. Z-axis indicates the percentage of positive findings on bone scintigraphy, which were noted more frequently in large lesions than in small lesions. Positive bone scintigraphy findings were also frequently associated with MR evidence of cortical involvement, particularly with transcortical lesions.

View larger version (108K): [in a new window]   Fig. 2A. —75-year-old man with biopsy-proven lung carcinoma who complained of right flank pain. Parasagittal T1-weighted MR image of spine shows large lesion without cortical involvement at T12 and diffuse lesion with cortical extension at L1.

View larger version (141K): [in a new window]   Fig. 2B. —75-year-old man with biopsy-proven lung carcinoma who complained of right flank pain. Planar bone scan shows moderate uptake at L1 but no recognizable uptake at T12.

View larger version (95K): [in a new window]   Fig. 3A. —56-year-old man who complained of back pain during treatment for biopsy-proven ileal carcinoid tumor. Sagittal T1-weighted MR image of lumbar spine shows large transcortical lesion at anteroinferior L3 vertebra.

View larger version (110K): [in a new window]   Fig. 3B. —56-year-old man who complained of back pain during treatment for biopsy-proven ileal carcinoid tumor. Axial T1-weighted MR image through inferior L3 shows lesion (arrows) extending through richly innervated periosteum of cortex. Note loss of adjacent fat plane compared with that of opposite side.

View larger version (137K): [in a new window]   Fig. 3C. —56-year-old man who complained of back pain during treatment for biopsy-proven ileal carcinoid tumor. Planar bone scan shows positive correlation with B, reflecting large area of cortical involvement.

View larger version (38K): [in a new window]   Fig. 4. —Graph of direct relationship between cortical involvement and lesion size. Incidence of transcortical and subcortical involvement was much higher in large lesions than in small lesions and in most small intramedullary lesions.

View larger version (113K): [in a new window]   Fig. 5A. —43-year-old woman with breast carcinoma who complained of back pain. Parasagittal T1-weighted MR image of spine shows large lesion at L1 vertebral body with cortical contact.

View larger version (105K): [in a new window]   Fig. 5B. —43-year-old woman with breast carcinoma who complained of back pain. Parasagittal T1-weighted MR image shows multiple small lesions at L3, L4, and S1 with cortical contact. L4 has two intramedullary lesions.

View larger version (155K): [in a new window]   Fig. 5C. —43-year-old woman with breast carcinoma who complained of back pain. Axial T1-weighted MR image through inferior L4 shows small lesion with cortical contact but no definite cortical break.

View larger version (97K): [in a new window]   Fig. 5D. —43-year-old woman with breast carcinoma who complained of back pain. Planar bone scan shows no recognizable activity at lesion sites.

View larger version (113K): [in a new window]   Fig. 6A. —67-year-old woman with lung carcinoma who complained of newly developed lower back pain. Parasagittal T1-weighted MR image of spine shows large lesion involving right pedicle and lamina of T12 (arrow).

View larger version (166K): [in a new window]   Fig. 6B. —67-year-old woman with lung carcinoma who complained of newly developed lower back pain. Axial T1-weighted MR image through T12 shows definite cortical destruction (asterisk).

View larger version (124K): [in a new window]   Fig. 6C. —67-year-old woman with lung carcinoma who complained of newly developed lower back pain. Planar bone scan shows no increased uptake on T12 despite MR imaging findings of large lesion with cortical destruction.

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