Sclerotic metastases from carcinoma of the prostate

Case contributed by Dr Chris O'Donnell

Presentation

Known carcinoma of the prostate, now upper cervical pain

Patient Data

Age: 65 years
Gender: Male
MRI

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.

Nuclear medicine

Bone scan to look for other lesions ie TcMDP

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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Case information

rID: 30165
Published: 26th Jul 2014
Last edited: 29th Apr 2019
Inclusion in quiz mode: Included

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