Vertebral metastasis (prostatic adenocarcinoma)

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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