Weekly Case

Title : Case 625

Age / Sex : 66 / M


Chief complaint : Right hip and leg pain for 5 months


                Accidentally discovered spine abnormality in L4

What is your diagnosis?

Two weeks later, you can see the final diagonosis with a brief discussion of this case (Please submit only one answer).

Courtesy : 
Sunghoon Park, Ajou University School of Medicine


 



Discussion


Answer: 


Hematopoietic marrow hyperplasia


 


Findings:


Radiographs of lumbar spine has no specific findings on the L4.


 


Sagittal reformatted CT images of lumbar spine shows suspicious sclerotic change of L4 body without definite mass lesion and cortical destruction.


 


MR Imaging showed moderated decrease signal intensities on T2- and T1-weighted image and homogeneous enhancement in L4 body without epidural and paravertebral soft tissue mass formation.


 


There was no interval change of bone marrow lesion on L4 in the MR images taken three months later.


 


The vertebral bone marrow lesion was pathologically confirmed hematopoietic marrow by imaging guided biopsy.


 


Differential Diagnosis:


Myeloma


 


Discussion:


 


The most extreme pattern of focal hypertrophy of the red marrow component


Hematopoietic cell proliferation triggered by increased peripheral demand or blood cell hypofunction


MR - compatible with that of normal hematopoietic marrow


: moderate decrease in signal intensity on T1-weighted SE images



  • similar or slightly lower than that of the adjacent intervertebral disk.


: intermediate to low signal intensity of T2 fast SE images


: moderate increase in signal intensity on fat-saturated intermediate- or T2-weighted fast SE images


: no or moderate enhancement after gadolinium injection


 


CT – normal


 


PET imaging : limited, but these areas may show a slight increased hypermetabolic uptake in comparison with adjacent red marrow.


 


References:



  1. Shigematsu Y, Hirai T, Kawanaka K, et al. Distinguishing imaging features between spinal hyperplastic hematopoietic bone marrow and bone metastasis. AJNR Am J Neuroradiol. 2014;35:2013–20.


 



  1. Vande Berg BC, Lecouvet FE, Galant C, Simoni P, Malghem J. Normal variants of the bone marrow at MR imaging of the spine. Semin Musculoskelet Radiol. 2009;13:87–96.


 



Correct Answer
Total applicants 27 Correct answers 15
Name Institution
김지은 서울대학교병원, 전문의
윤유성 순천향대 부천병원, 전문의
김동언 국군양주병원, 전문의
김기욱 국군대전병원, 전문의
장성원 중앙보훈병원, 전공의
강지희 서울대학교병원, 전문의
송윤아 전문의
조은경 새움병원, 전문의
신재환 국군춘천병원, 전문의
이혜란 전문의
이진영 전문의
장민영 국민건강보험공단 일산병원, 전문의
전성우 전문의
김창현 365병원, 전문의
김보람 전문의


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