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Primary Vertebral Osteosarcoma: Imaging Findings¹

¹ From the Departments of Radiology (H.I., M.S.), Pathology and Laboratory Medicine (K.K.U.), and Orthopedic Surgery (T.C.S.), Mayo Clinic, Ch2–290, 200 First St SW, Rochester, MN 55905. Received February 10, 2003; revision requested April 25; final revision received July 18; accepted August 22. Address correspondence to M.S. (e-mail: sundaram.murali@mayo.edu).

View larger version (113K): [in a new window]   Figure 1. Transverse CT scan in 32-year-old man shows destructive lesion of sacral body and left sacral ala caused by osteoblastic osteosarcoma, with large partially mineralized soft-tissue mass (arrows).

View larger version (83K): [in a new window]   Figure 2a. (a) Transverse CT scan of thoracic vertebra in 46-year-old man shows more diffusely mineralized mass (arrow) arising from and associated with some destruction of the right transverse process and pedicle caused by chondroblastic osteosarcoma associated with intraspinal extension. (b) Lateral radiograph of cervical spine in 34-year-old woman shows intense sclerosis (*) of posterior elements, body, and dens of C2 caused by osteoblastic osteosarcoma that completely obscures normal bony outlines and extends superiorly to the arch of C1, which appears intact. (c) Lateral radiograph of lumbar spine in 37-year-old man shows osteoblastic osteosarcoma with "ivory vertebra" (*) appearance at L4 involving body and pedicles.

View larger version (136K): [in a new window]   Figure 2b. (a) Transverse CT scan of thoracic vertebra in 46-year-old man shows more diffusely mineralized mass (arrow) arising from and associated with some destruction of the right transverse process and pedicle caused by chondroblastic osteosarcoma associated with intraspinal extension. (b) Lateral radiograph of cervical spine in 34-year-old woman shows intense sclerosis (*) of posterior elements, body, and dens of C2 caused by osteoblastic osteosarcoma that completely obscures normal bony outlines and extends superiorly to the arch of C1, which appears intact. (c) Lateral radiograph of lumbar spine in 37-year-old man shows osteoblastic osteosarcoma with "ivory vertebra" (*) appearance at L4 involving body and pedicles.

View larger version (135K): [in a new window]   Figure 2c. (a) Transverse CT scan of thoracic vertebra in 46-year-old man shows more diffusely mineralized mass (arrow) arising from and associated with some destruction of the right transverse process and pedicle caused by chondroblastic osteosarcoma associated with intraspinal extension. (b) Lateral radiograph of cervical spine in 34-year-old woman shows intense sclerosis (*) of posterior elements, body, and dens of C2 caused by osteoblastic osteosarcoma that completely obscures normal bony outlines and extends superiorly to the arch of C1, which appears intact. (c) Lateral radiograph of lumbar spine in 37-year-old man shows osteoblastic osteosarcoma with "ivory vertebra" (*) appearance at L4 involving body and pedicles.

View larger version (143K): [in a new window]   Figure 3a. Telangiectatic osteosarcoma in 37-year-old woman. (a) Lateral radiograph of spine shows destruction of posterior half of T12 (*), with cortical destruction and complete disappearance of posterior elements without sclerosis of bone or identifiable mineral in lesion. Black artifact in posterior portion of vertebral body could not be erased. (b) Sagittal T2-weighted MR image of spine (repetition time msec/echo time msec, 4,290/92) shows posterior elements replaced by expansive mass containing large and small fluid-fluid levels (arrows). Posterior half of vertebral body (arrowhead) shows areas of abnormal signal intensity caused by tumor.

View larger version (187K): [in a new window]   Figure 3b. Telangiectatic osteosarcoma in 37-year-old woman. (a) Lateral radiograph of spine shows destruction of posterior half of T12 (*), with cortical destruction and complete disappearance of posterior elements without sclerosis of bone or identifiable mineral in lesion. Black artifact in posterior portion of vertebral body could not be erased. (b) Sagittal T2-weighted MR image of spine (repetition time msec/echo time msec, 4,290/92) shows posterior elements replaced by expansive mass containing large and small fluid-fluid levels (arrows). Posterior half of vertebral body (arrowhead) shows areas of abnormal signal intensity caused by tumor.

View larger version (146K): [in a new window]   Figure 4. Lateral radiograph of cervical spine in 46-year-old woman with contiguous multilevel osteoblastic osteosarcoma, with sclerosis of the anterior margins of C3-4 and associated partial collapse and destruction.

View larger version (151K): [in a new window]   Figure 5a. (a) Transverse CT scan of vertebra in 20-year-old man shows expansive mass (arrows) with an outer shell of bone and no soft-tissue mass. Entire left half of posterior elements and posterior body were involved. More than 50% of lesion was mineralized, and dense bone invaded spinal canal. This mass was a grade 3 osteoblastic osteosarcoma. (b) Transverse CT scan of vertebra in 30-year-old woman shows expansive lesion (arrows), less expansive than that in a, with no soft-tissue mass and clearly defined margins. Entire lesion was ossified; portions of it occupied spinal canal; and it was in partial contact with the psoas muscle superolaterally. Fat plane was evident inferolaterally between psoas muscle and ossified tumor. This mass was a grade 3 osteoblastic osteosarcoma.

View larger version (163K): [in a new window]   Figure 5b. (a) Transverse CT scan of vertebra in 20-year-old man shows expansive mass (arrows) with an outer shell of bone and no soft-tissue mass. Entire left half of posterior elements and posterior body were involved. More than 50% of lesion was mineralized, and dense bone invaded spinal canal. This mass was a grade 3 osteoblastic osteosarcoma. (b) Transverse CT scan of vertebra in 30-year-old woman shows expansive lesion (arrows), less expansive than that in a, with no soft-tissue mass and clearly defined margins. Entire lesion was ossified; portions of it occupied spinal canal; and it was in partial contact with the psoas muscle superolaterally. Fat plane was evident inferolaterally between psoas muscle and ossified tumor. This mass was a grade 3 osteoblastic osteosarcoma.

View larger version (122K): [in a new window]   Figure 6a. (a) Lateral radiograph of cervical spine in 23-year-old woman with vertebra plana (*) at C6. Body is sclerotic, with bone production anteriorly secondary to osteoblastic osteosarcoma. (b) Delayed contrast-enhanced sagittal T1-weighted MR image (600/14) of cervical spine shows area of diffuse low signal intensity in collapsed C6 (*), with extradural mass displacing the cord posteriorly. Area of slightly increased signal intensity at C5 and C7 is of unknown clinical significance. There had been no previous radiation therapy. (c) Sagittal T2-weighted MR image (3,816/90) of cervical spine shows area of low signal intensity (*), as expected with a sclerotic lesion, and large posterior mass compressing spinal cord.

View larger version (134K): [in a new window]   Figure 6b. (a) Lateral radiograph of cervical spine in 23-year-old woman with vertebra plana (*) at C6. Body is sclerotic, with bone production anteriorly secondary to osteoblastic osteosarcoma. (b) Delayed contrast-enhanced sagittal T1-weighted MR image (600/14) of cervical spine shows area of diffuse low signal intensity in collapsed C6 (*), with extradural mass displacing the cord posteriorly. Area of slightly increased signal intensity at C5 and C7 is of unknown clinical significance. There had been no previous radiation therapy. (c) Sagittal T2-weighted MR image (3,816/90) of cervical spine shows area of low signal intensity (*), as expected with a sclerotic lesion, and large posterior mass compressing spinal cord.

View larger version (144K): [in a new window]   Figure 6c. (a) Lateral radiograph of cervical spine in 23-year-old woman with vertebra plana (*) at C6. Body is sclerotic, with bone production anteriorly secondary to osteoblastic osteosarcoma. (b) Delayed contrast-enhanced sagittal T1-weighted MR image (600/14) of cervical spine shows area of diffuse low signal intensity in collapsed C6 (*), with extradural mass displacing the cord posteriorly. Area of slightly increased signal intensity at C5 and C7 is of unknown clinical significance. There had been no previous radiation therapy. (c) Sagittal T2-weighted MR image (3,816/90) of cervical spine shows area of low signal intensity (*), as expected with a sclerotic lesion, and large posterior mass compressing spinal cord.