Vertebral metastasis (prostatic adenocarcinoma)

Case contributed by Dr Angel Donato

Presentation

Low back pain.

Patient Data

Age: 65 years
Gender: Male

MRI lumbar spine demonstrates a diffuse marrow infiltration that replacing most of the L5 vertebral, T1 and T2 hypointense, STIR heterogeneously hyperintense, which show enhancement on post-contrast images with associated contiguous soft tissue component extends from the left vertebral body with an invasion of the epidural space.

Case Discussion

The patient had a known history of castrate-resistant prostatic cancer. 

Prostatic carcinoma is the most common malignant tumor in men and the second cause of cancer-related deaths in men. 95% of prostate cancers are adenocarcinomas.  Prostate cancer can spread by local invasion, lymphatic spread or by hematogenous metastases.   Bones are the most common sites of hematogenous metastases, and the spine is the most common site for bone metastases because of the abundance of red marrow.

According to Moulopoulos and Koutoulidis, osteoblastic metastases in MRI are typical very hypointense on T1-weighted images. Mild or no hyperintensity on STIR (look for T2 halo sign). Mild or no enhancement on post-contrast T1-weighted Images. ADC values may overlap with those of normal marrow

Osteolytic metastases in MRI are typical hypointense to intervertebral discs and muscle on T1-weighted images. Moderately to markedly hyperintense on STIR. More than 40% enhancement on post-contrast T1-weighted images. No or less than 20 % signal loss on out-of-phase images. High ADC values (often higher than 1.0 × 10−3 mm2/s).

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Case information

rID: 59151
Published: 20th Apr 2018
Last edited: 22nd Apr 2018
Inclusion in quiz mode: Included
Institution: Hospital Militar Central, Bogota, Colombia

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