Presentation
Known case of breast cancer with hip and lumbar pain.
Patient Data
There is a lytic lesion with slightly irregular margins and cortical breakthrough at femoral metaphysis and greater trochanter of right femur.
Sagittal spinal T2-WI and STIR sequences show multiple T2-WI hypointense (sclerotic) and expansile lesions involving the T11 and L5 and S1 and lower sacral vertebral bodies with extention into the adjacent epidural space and pathologic fracture at T11 level.
Pelvic MRI showes multiple abnormal signal intensity lesions on STIR and T1-WI and T2-WI sequences, the most prominent at right greater trochanter.
Case Discussion
When breast cancer metastasizes, the most common site is the bones, and most commonly spreads to the spine, pelvis, ribs, and long bones. The femur is the most common site of metastatic breast cancer among long bones. Pain is the most common symptom of bone metastasis.
In the spinal column bone, epidural space, leptomeninges, and spinal cords may be involved with metastasis. The combination of unenhanced T1-weighted sequence and STIR is the most useful sequences for detection of malignant bone marrow abnormalities. MRI features of pathologic fracture include: convex posterior border of the vertebral body, abnormal signal intensity extending to the pedicle and posterior elements, and epidural or paraspinal mass, and multiple spinal lesions. The MR fluid sign is characteristic for avascular necrosis and benign fractures, but up to 40% of malignant fractures may show this sign. Epidural extension contiguous with a vertebral body lesion and sparing of meningovertebral ligament giving the draped curtain appearance.
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