OBJECTIVETo report 2 rare cases of benign notochordal cell tumor (BNCT), according to WHO classification of tumors of soft tissue and bone (4th edition). Their radiologic and clincopathologic features and differential diagnosis were investigated.

METHODSTwo cases of BNCT were studied by retrospective review of the clinical, radiologic, pathologic and immunophenotypical findings. Related literatures were reviewed at the same time.

RESULTSCase 1 was a 53-year-old man, and case 2 was a 61-year-old woman. Radiographically, both patients presented with abnormal imaging findings in the fifth cervical vertebral body with the lesions located within the bone but without extra osseous mass. Histopathologically, the lesions lacked lobular architecture and extracellular myxoid matrix. The tumor cells were vacuolated and had centrally or peripherally placed round or oval nuclei with small nucleoli, mimicking mature adipocytes. No cytological atypia or mitotic figures were seen. The affected bone trabeculae were sclerotic and islands of bone marrow were often entrapped within the tumor.

CONCLUSIONSAlthough sharing similar anatomic distribution and immunophenotype to those of chordoma, BNCT has distinct radiologic and pathologic features and different treatment and prognosis. The differential diagnosis between BNCT and chordoma requires detailed clinical, radiologic and histopathologic evaluations.

Cervical Vertebrae ; diagnostic imaging ; pathology ; Chordoma ; pathology ; Diagnosis, Differential ; Diagnostic Imaging ; Female ; Humans ; Male ; Middle Aged ; Notochord ; diagnostic imaging ; pathology ; Radiography ; Retrospective Studies ; Spinal Neoplasms ; diagnostic imaging ; pathology

OBJECTIVETo investigate the clinical value of different magnetic resonance (MR) pulse sequences in diagnosis of spinal metastatic tumor.

METHODSFifteen patients with clinically suspected spinal metastatic tumor were included in this study. These patients were with documented primary tumors. Four MR pulse sequences, T1-weighted spin echo (T1WI SE), T2-weighted fast spin echo (T2WI FSE), short time inversion recovery (STIR), and gradient echo 2-D multi echo data imaging combination (GE Me-2D) were used to detect spinal metastasis.

RESULTSFifteen vertebral bodies were entire involvement, 38 vertebral bodies were section involvement, and totally 53 vertebral bodies were involved. There were 19 focal infections in pedicle of vertebral arch, 15 metastases in spinous process and transverse process. Fifty-three vertebral bodies were abnormal in T1 WI SE and GE Me-2D, 35 vertebral bodies were found abnormal in T2WI FSE, and 50 vertebral bodies were found abnormal in STIR. The verges of focal signal of involved vertebral bodies were comparatively clear in T1WI SE, comparatively clear or vague in T2WI FSE, vague in STIR, and clear in GE Me-2D.

CONCLUSIONSGE Me-2D may be the most sensitive technique to detect metastases. So three sequences (T1WI SE, T2WI FSE, GE Me-2D) can demonstrate the early changes of spinal metastasis roundly.

Cervical Vertebrae ; diagnostic imaging ; Coccyx ; diagnostic imaging ; Humans ; Lumbar Vertebrae ; diagnostic imaging ; Magnetic Resonance Imaging ; methods ; Neoplasm Metastasis ; pathology ; Radiography ; Sacrum ; diagnostic imaging ; Sensitivity and Specificity ; Spinal Neoplasms ; pathology ; secondary ; Spine ; diagnostic imaging ; Thoracic Vertebrae ; diagnostic imaging

Humans ; Male ; Middle Aged ; Paraganglioma, Extra-Adrenal ; diagnosis ; diagnostic imaging ; drug therapy ; Radiography ; Spinal Neoplasms ; diagnosis ; diagnostic imaging ; drug therapy

OBJECTIVE: To evaluate the value of CT spectral curve in differentiating spinal tumor metastasis (STM) from spinal infections (SI). METHODS: In the study, 29 STM and 18 SI patients proved pathologically and clinically were examined by dual energy spectral CT (DESCT). The monochromatic images and CT spectral curves were generated automatically by GSI Viewer software. The attenuation values at different energy levels (40-140 keV, every 10 keV), the attenuation values of the lesions on the conventional polychromatic CT images and the gradients of the curve were calculated and compared between STM and SI. RESULTS: The median age of STM and SI (58 years vs. 64 years) were not significantly different (U=171, P=0.4). The attenuation values of STM at 40-100 keV were 281.79 (143.67, 446.19) HU, 199.68 (100.04, 321.49) HU, 151.54 (81.47, 243.49) HU, (122.64±27.72) HU, (99.90±23.88) HU, (85.82±21.61) HU, and (75.94±20.27) HU, respectively, which were significantly higher than SI: 185.29 (164.19, 277.03) HU, 138.44 (124.98, 238.56) HU, 105.46 (92.94, 169.53) HU, (93.77±15.55) HU, (79.15±12.84) HU, (68.99±11.75) HU, and (62.22±11.71) HU (all P < 0.05). The attenuation values at 110-140 keV and the attenuation value on the conventional CT images were not significantly different between STM and SI. The gradient of CT spectral curve of STM was 2.43±0.58, which was higher than the value of 1.50±0.40 for SI (P < 0.001). Using 1.72 and 248.80 HU as the threshold value for CT spectral curve slope and the attenuation value at 40 keV, could obtain the area under receiver operating characteristic (ROC) curve of 0.905 and 0.892, sensitivity of 88.0% and 80.0%, and specificity of 76.9% and 92.3%. CONCLUSION CT spectral curve provides valuable semi-quantitative information for the differential diagnosis of STM and SI, which can be used as a supplement to traditional CT imaging.
Diagnosis, Differential ; Humans ; Middle Aged ; ROC Curve ; Sensitivity and Specificity ; Spinal Cord Neoplasms ; Spinal Neoplasms/diagnostic imaging* ; Tomography, X-Ray Computed

Fatal Outcome ; Humans ; Magnetic Resonance Imaging ; Male ; Mediastinal Neoplasms ; complications ; diagnostic imaging ; pathology ; surgery ; Mediastinum ; diagnostic imaging ; pathology ; Neuroectodermal Tumors, Primitive, Peripheral ; complications ; diagnostic imaging ; pathology ; surgery ; Radiography ; Spinal Cord Diseases ; diagnostic imaging ; etiology ; pathology ; Young Adult

Adult ; Aged ; Combined Modality Therapy ; Female ; Humans ; Male ; Middle Aged ; Neurosurgical Procedures ; methods ; Spinal Cord Neoplasms ; diagnostic imaging ; pathology ; surgery ; Spinal Neoplasms ; diagnostic imaging ; pathology ; surgery ; Thoracic Vertebrae ; diagnostic imaging ; pathology ; surgery ; Thoracoscopy ; methods ; Tomography, X-Ray Computed ; Treatment Outcome

OBJECTIVETo analyze the radiogenic distribution in the sacrum in whole-body bone scanning.

METHODSA total of 212 patients receiving whole-body bone scanning without any explicit bone metastases were divided into different age and gender groups. The radioactive distribution in the sacrum in whole-body bone scanning was analyzed statistically.

RESULTSOf these cases, 31.1% presented with thin radioactive distribution in the sacrum and 11.3% exhibited increased radioactive distribution. Normal radioactive distribution in the sacrum was found in 57.6% of the cases. In both male and female elderly patients (>70 years), the rate of normal radioactive distribution in the sacrum was obviously reduced with increased rate of thin radioactive distribution. The female elderly patients showed higher rate of increased radioactive distribution in the sacrum than male elderly patients.

CONCLUSIONThe radioactive distribution in the sacrum is similar between female and male patients. Elderly male patients over 70 years have generally thin radioactive distribution in the sacrum due to the presence of osteoporosis, which is also associated with latent fracture of the sacrum to result in increased radioactive distribution in the sacrum in whole-body bone scanning.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Male ; Middle Aged ; Neoplasms ; diagnostic imaging ; pathology ; Radionuclide Imaging ; Sacrum ; diagnostic imaging ; Spinal Neoplasms ; diagnostic imaging ; secondary ; Technetium Tc 99m Medronate ; pharmacokinetics ; Whole Body Imaging ; Young Adult

Adult ; Bone Cysts, Aneurysmal ; diagnostic imaging ; pathology ; surgery ; Diagnosis, Differential ; Female ; Follow-Up Studies ; Giant Cell Tumor of Bone ; pathology ; Humans ; Osteosarcoma ; pathology ; Radiography ; Spinal Diseases ; diagnostic imaging ; pathology ; surgery ; Spinal Neoplasms ; pathology ; Spine ; diagnostic imaging ; pathology ; surgery

OBJECTIVETo evaluate the feasibility, safety and efficacy of atlas pedicle screws system fixation and fusion for the treatment of upper cervical diseases.

METHODSTwenty-three consecutive patients with upper cervical disorders requiring stabilization, including 19 cases of atlantoaxial dislocation (4 congenital odontoid disconnections, 6 old odontoid fractures, 4 fresh odontoid fractures of Aderson II C, 3 ruptures of the C(1) transverse ligament, and 2 fractures of C(1)), 2 cases of C2 tumor (instability after the resection of the tumors), and 2 giant neurilemomas of C(2)-C(3)(instability after resection of the tumors), were treated by posterior fixation and fusion with the atlas pedicle screw system, in which the screws were inserted through the posterior arch of C1. The operative time, bleeding volume and complications were reported. All patients were immobilized without external fixation or with rigid cervical collars for 1-3 months. All patients were followed up and evaluated with radiographs and CT.

RESULTSIn the 23 patients, 46 C(1) pedicle screws, 42 C(2) pedicle screws and 6 lower cervical lateral mass screws and 2 lower cervical pedicle screws were placed. The mean operative time and bleeding volume was 2.7 hours and 490 ml respectively. No intraoperative complications were directly related to surgical technique. No neurological, vascular or infective complications were encountered. All patients were followed up for 3-36 months (average 15 months). Firm bony fusion was documented in all patients after 3-6 months. One patient with atlas fracture showed anterior occipitocervical fusion. There was no implant failure.

CONCLUSIONSPosterior fixation and fusion of the atlas pedicle screw system is feasible and safe for the treatment of upper cervical diseases, and may be applicable to a larger number of patients.

Adult ; Bone Screws ; Cervical Atlas ; diagnostic imaging ; injuries ; pathology ; surgery ; Feasibility Studies ; Female ; Fracture Fixation, Internal ; instrumentation ; Humans ; Joint Dislocations ; diagnostic imaging ; surgery ; Male ; Middle Aged ; Odontoid Process ; abnormalities ; diagnostic imaging ; pathology ; surgery ; Spinal Fractures ; diagnostic imaging ; surgery ; Spinal Fusion ; instrumentation ; Spinal Neoplasms ; diagnostic imaging ; pathology ; surgery ; Tomography, X-Ray Computed ; Treatment Outcome

Craniospinal radiation is one of essential components in the treatment flow for a number of central nervous system malignancies. Meticulous attention to technique and dosimetry is required to produce optimum tumor control. In this paper, an optimized treatment regimen was proposed based on multiple techniques. The CT images for a 17-year-old male patient in need of craniospinal radiation were acquired for 3D conformal treatment planning. The split-beam technique, the extended penumbra fields matching technique, and the multiple leaf collimator segments and extended SSD technique were synthesized in the treatment regimen so as to work out an optimized treatment plan. The added few segments improved the dose homogeneity in spinal cord. The maximal point dose was decreased from 124% to 108% of the prescribed dose in it. Comparative study on the anthropomorphic phantom showed that the data collected by thermoluminescent detectors and the data obtained by calculation were basically coincident. These results suggest that the proposed technique be clinically acceptable.
Adolescent ; Brain Neoplasms ; diagnostic imaging ; radiotherapy ; Humans ; Magnetic Resonance Imaging ; Male ; Neoplasms, Germ Cell and Embryonal ; radiotherapy ; Radiometry ; methods ; Radiotherapy Planning, Computer-Assisted ; Radiotherapy, Conformal ; methods ; Spinal Cord Neoplasms ; diagnostic imaging ; radiotherapy ; Tomography, X-Ray Computed