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Case 257 year old man with back pain

Imaging Findings

Slow growing tumor replacing entire vertebral body

Intermediate to low intensity on T1, bright on T2, enhances mildly and homogeneously

Expansile, involves entire vertebral body, with paraspinal component

Leaves struts of bony trabeculae as it grows

Differential Diagnosis

Aggressive hemangioma (in contra-distinction to incidental asymptomatic hemangiomas), usually does not contain fat, often extend into the posterior neural arch, have cortical expansion, more common T-spine, paraspinal soft tissue mass, very vascular

Plasmacytoma/multiple myeloma

Metastatic disease

Chordoma

Chondromsarcoma

Hemangioendothelioma

Fibrous dysplasia

Solitary Plasmacytoma

Classic “mini brain” appearance described by Major and Helms: AJR July 1, 2000; 175 (1): 261-263

Axial skeleton 25-60%, usually spine

Associated with multiple myeloma– if not present at diagnosis, most develop systemic marrow involvement in 2-4 yrs.

Treatment: Radiotherapy

CT and Angiogram of “Typical” Hemangioma

“Mini Brain” = Plasmacytoma