MRI Lumbar Spine
The basic principles of the MRI scan of the lumbar spine.
Pathology - Osseous Metastases
The most common malignancies that metastasize to the bone are carcinomas originating from the breast, lung, prostate, thyroid, and kidney. Breast carcinoma and prostate carcinoma, in particular, have a specific preference for metastasizing to the spine. The spine is rich in red bone marrow (compared to the peripheral skeleton) with an extensive capillary network. Combined with the low blood flow rate locally, the spine is an 'attractive environment' for metastases.
Metastases can be either symptomatic or asymptomatic (the majority is asymptomatic). This largely depends on the size, the presence of a pathological fracture, and nerve or myelum compression.
Some 'red flags' to consider the presence of vertebral metastases include back pain lasting more than six weeks, age over 60, nighttime pain/pain while lying down (blood pooling), and an oncological history.
MRI Signal Intensities
The signal intensity of osseous metastases on an MRI scan depends on the type of tissue/substance that makes up the majority of the metastasis, particularly the degree of bone mineralization and the presence of fatty/hemorrhagic/vascular components.
A general (rough) distribution:
- Osteoblastic (sclerotic) metastases (Fig. 40): low signal intensity on T1 and T2.
- Osteolytic metastases (Fig. 41): intermediate to low signal intensity on T1 & high signal intensity on T2 with fat suppression (e.g., STIR sequence). Variable on T2 without fat suppression (intermediate to increased signal but often less distinct compared to T1 and T2 with fat suppression).
- Mixed osteoblastic/osteolytic: low signal intensity on T1 and low and/or heterogeneous signal intensity on T2.
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Text
drs. A. van der Plas (MSK radiologist Maastricht UMC+)
With special thanks to:
dr. W. Henneman (neuroradiologist Maastricht UMC+)
Illustrations
drs. A. van der Plas (MSK radiologist Maastricht UMC+)
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08/10/2023
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