Article

Preoperative estimation of metastatic vertebral tumors.

Department of Orthopaedic Surgery, Kanazawa Medical University, Ishikawa, Japan.
International Orthopaedics (Impact Factor: 2.32). 02/2000; 24(2):71-4. DOI: 10.1007/s002640000123
Source: PubMed

ABSTRACT Total en bloc spondylectomy was performed in 22 patients with metastatic vertebral tumors. Osteolytic lesions were present in 15 cases while 7 cases had osteoblastic or mixed lesions. We measured the dimensions of the tumors preoperatively using magnetic resonance imaging (MRI) and computerized tomography (CT), and postoperatively by histological examination of the resected specimens. In the osteolytic group, the dorsoventral and transverse diameters of the metastatic tumor as measured on MRI were significantly greater compared to those determined by the histological examination. On the other hand, the same parameters measured by CT were smaller than the histologically determined dimensions. Although there were no significant differences between measurements of osteoblastic and osteolytic tumors, CT underestimated dimensions in osteoblastic or mixed tumors more than in those of osteolytic tumors. Estimation of tumor dimensions and local invasion using MRI and CT should be interpreted carefully.

0 Bookmarks
 · 
36 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objectif Rechercher l’apport de l’imagerie par résonance magnétique (IRM) nucléaire pour la détection des métastases tumorales touchant la jonction discovertébrale (JDV) sur des échantillons cadavériques et chez des patients. Comparaison avec les données histologiques. Méthodes Trente JDV provenant de dix cadavres présentant des métastases osseuses avérées ont été étudiées à l’IRM. Des coupes anatomiques et des évaluations histologiques ont été pratiquées ; les coupes anatomiques ont ensuite été confrontées aux images d’IRM. Pour l’étude clinique, l’IRM de trois patients présentant des métastases vertébrales a été relue. Résultats À l’IRM, l’intensité du signal des métastases du corps vertébral était variable. Cet examen n’a pas permis de détecter les foyers de métastases envahissant les plaques cartilagineuses. L’examen histologique a retrouvé une infiltration de la JDV par du tissu tumoral chez 11 (69 %) des 16 JDV avec contour irrégulier et pour cinq (31 %) des JDV interrompues. Chez trois cadavres et chez trois patients, l’examen histologique a montré une métastase du disque intervertébral. Dans aucun prélèvement, l’IRM n’a permis de montrer un envahissement tumoral du disque. Conclusions Nos résultats permettent de soutenir la notion que les métastases tumorales peuvent envahir la plaque cartilagineuse, par l’intermédiaire d’une dégradation de ses constituants, permettant ainsi un contact direct entre la tumeur et le disque. Il est possible que l’IRM ou l’examen macroscopique, voire les deux à la fois, échouent à détecter un envahissement tumoral minime de la JDV car les images des petits foyers de métastases peuvent être masquées par les anomalies de morphologie de la plaque cartilagineuse vertébrale.
    Revue Du Rhumatisme - REV RHUM. 01/2009; 76(1):55-61.
  • [Show abstract] [Hide abstract]
    ABSTRACT: To investigate the use of magnetic resonance imaging in the detection of metastatic tumors involving the discovertebral junction of the spine in cadaveric specimens and patients, with histologic findings as the reference standard. Magnetic resonance imaging studies were performed on 30 DVJs in 10 cadavers with documented metastatic bone disease. Anatomic sectioning and histologic evaluations were performed, and anatomic slices were correlated with the magnetic resonance images. For clinical study, magnetic resonance imaging examinations in three patients with vertebral metastasis were reviewed. On magnetic resonance imaging, the signal intensity characteristics of vertebral body metastases were variable. Magnetic resonance imaging failed to detect metastatic foci invading the cartilaginous endplates. On microscopic examination, infiltration of the discovertebral junction by tumorous tissue was found in 11 (69%) of the 16 discovertebral junctions that had an irregular contour, and in 5 (31%) disrupted discovertebral junctions. In three specimens and three patients, microscopic examination revealed tumor metastasis to the intervertebral disc. In no specimen magnetic resonance imaging afforded depiction of discal invasion by tumor. Our results lend further support to the theory that metastatic tumors can invade the cartilaginous endplate through defects in its substance, allowing direct contact of tumor and disc. Minimal tumor invasion of the discovertebral junction may not be identified at magnetic resonance imaging or gross anatomic inspection, or both, because small metastatic foci may be obscured by abnormalities in the morphology of the cartilaginous endplate.
    Joint, bone, spine: revue du rhumatisme 11/2008; 76(1):50-6. · 2.25 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: • Computed tomography (CT) is a high-radiation-dose examination, which should therefore be both justified and tailored to the clinical need. • CT of solitary bone lesions may provide information on tumour mineralization difficult to identify on plain film or MR. • Non-contrast-enhanced CT of the thorax is appropriate for staging of metastatic bone sarcoma. • Whole-body CT in older patients should be considered where the “index” bone lesion may be a metastasis. • CT with CT fluoroscopy is ideal for guiding bone biopsy and interventional procedures. Steps to minimize radiation dose are important for both the patient and operator. • Ingenuity in patient positioning can produce high-quality scans of limb lesions (by removing unnecessary parts of the patient from the scan plane).

Full-text

View
0 Downloads
Available from