Presentation
Known carcinoma of the prostate, now upper cervical pain
Patient Data
Note: This case has been tagged as "legacy" as it no longer meets image preparation and/or other case publication guidelines.
GP thought likely disc pathology therefore MRI requested
Loss of normal bone marrow signal in the C2 vertebra; best identified on the T1 sequence, barely visible on conventional FSE T2 and with only minimal increased signal on STIR since the lesion is predominately sclerotic.
Lesion in C2 is hot and there is one other hot spot in the left sacral alum
Gross sclerosis without bone destruction.
Case Discussion
Sclerotic bone mets are more difficult to detect on MRI, especially T2-weighted sequences, as they are not associated with a marked increase in water. T1-weighted imaging is often the most sensitive (as in this case) as there is replacement of the normal yellow bone marrow i.e. detection does not rely on increased water within the tumor mass rather loss of the normal T1 hyperintense bone marrow signal.
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