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

STUDY DESIGN: Case report. OBJECTIVES: We report the case of a long, solitary, rosary-shaped neurofibroma that was misdiagnosed as another disease due to the patient's surgical history involving repetitive procedures and its abnormal appearance. SUMMARY OF LITERATURE REVIEW: Neurofibroma is an intradural-extramedullary spinal tumor. It is generally not difficult to diagnose due to its frequent occurrence and specific magnetic resonance imaging (MRI) findings. However, to date, neurofibromatosis stigmata and long, solitary, rosary-shaped neurofibromas have rarely been reported. MATERIALS AND METHODS: A 60-year-old woman was admitted to our hospital due to persistent pain, despite previous surgery and repetitive procedures. On physical examination, vision loss, hearing loss, skin discoloration, or subcutaneous nodules were not observed. A neurologic examination revealed normal motor and sensory function and voiding sensation. No pathologic reflexes such as the Babinski sign were observed. Previous sequential MRIs revealed intradural lesions that progressed from the thoracic vertebra 11 to the lumbar vertebra 3. She had no signs of neurofibromatosis stigmata, and the neurologic examination was unremarkable. The initial diagnosis was based on serial MRIs, which revealed a parasite infestation, a spinal cord tumor (myxopapillary-type ependymoma with hemorrhage), arachnoiditis, and vascular malformations. Total mass excision was performed, and the final diagnosis was neurofibroma. RESULTS: There were no signs of a tumor remnants or local recurrence in a 1-year follow-up MRI study. CONCLUSIONS: Although intradural spinal tumors are very rare, their clinical features are nonspecific and resemble other degenerative spinal diseases, including spinal stenosis and disc herniation. These diseases may easily be overlooked by physicians.
Arachnoid ; Arachnoiditis ; Christianity ; Diagnosis ; Diagnostic Errors ; Ependymoma ; Female ; Follow-Up Studies ; Hearing Loss ; Humans ; Magnetic Resonance Imaging ; Middle Aged ; Neurofibroma* ; Neurofibromatoses ; Neurologic Examination ; Parasites ; Physical Examination ; Recurrence ; Reflex ; Reflex, Babinski ; Sensation ; Skin ; Spinal Cord Neoplasms ; Spinal Diseases ; Spinal Stenosis ; Spine ; Vascular Malformations

No abstract available.
Adult ; Biopsy ; Carcinoma, Squamous Cell/complications/*diagnostic imaging/pathology ; Female ; *Fluorodeoxyglucose F18 ; Humans ; Meningomyelocele/*complications/diagnosis ; *Positron Emission Tomography Computed Tomography ; Predictive Value of Tests ; *Radiopharmaceuticals ; Spinal Neoplasms/complications/*diagnostic imaging/pathology

STUDY DESIGN: Case report. OBJECTIVES: We report two cases regarding epidural air pseudocyst at the lumbar spine. SUMMARY OF LITERATURE REVIEW: Epidural air pseudocyst at the lumbar spine that provokes radiating pain and neurologic symptoms can be misdiagnosed as an epidural tumor or HIVD. Consequently, proper diagnosis and treatment of the epidural air pseudocyst at the lumbar spine is necessary. MATERIALS AND METHODS: We report on two patients with radiculopathy and neurologic symptoms resulting from epidural air pseudocysts. In one patient, the epidural air pseudocyst was found within the epidural ligament flavum area on an MRI, and fluoroscopic-guided FNA (fine needle aspiration) was performed. In the other, the epidural air pseudocyst was found behind the posterior longitudinal ligament and was accompanied by spinal stenosis. In this patient, we conducted open cystectomy and posterior decompression surgery. Results: After treatment, all patients have showed symptom improvement and they are currently living without discomfort. RESULTS: After treatment, all patients have showed symptom improvement and they are currently living without discomfort. CONCLUSIONS: Due to frequent misdiagnosis, the careful diagnosis of lumbar epidural air pseudocyst is necessary. Physicians should select a proper treatment plan concerning the patient's condition and the location of the lesion.
Biopsy, Fine-Needle ; Cystectomy ; Decompression ; Diagnosis ; Diagnostic Errors ; Epidural Neoplasms ; Humans ; Ligaments ; Longitudinal Ligaments ; Magnetic Resonance Imaging ; Needles ; Neurologic Manifestations ; Radiculopathy ; Spinal Stenosis ; Spine*

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

As a result of the complex anatomy in upper cervical spine, the operative treatment of axis neoplasms is always complicated. Although the procedure for the second cervical vertebra (C2) surgery had been described previously in diverse approaches and reconstruction forms, each has its own limitations and restrictions that usually result in less satisfactory conclusions. The purpose of this study was to evaluate the operation efficacy for axis tumors by using a combined anterior (retropharyngeal) cervical and posterior approach in achieving total resection of C2 and circumferential reconstruction. Eight consecutive C2 tumor patients with mean age of 47.6 years in our institute sequentially underwent vertebra resection and fixation through aforementioned approach from Jan. 2006 to Dec. 2010. No surgical mortality or severe morbidity occurred in our group. In terms of complications, 2 cases developed transient difficulty in swallowing liquids (one of them experienced dysphonia) and 1 developed cerebrospinal fluid leakage (CSFL) that was resolved later. During a mean follow-up period of 31.9 months, the visual analogue scale (VAS) and Japanese orthopedic association (JOA) score revealed that the pain level and neurological function in all patients were improved postoperatively, and there was no evidence of fixation failure and local recurrence. It is concluded that the anterior cervical retropharyngeal approach permits a visible exposure to facilitate the C2 vertebra resection and perform an effective anterior reconstruction at the same time. The custom-made mesh cage applied in our cases can be acted as a firm and convenient implant in circumferential fixation.
Adult ; Axis, Cervical Vertebra ; diagnostic imaging ; surgery ; Combined Modality Therapy ; Female ; Humans ; Laminectomy ; methods ; Male ; Middle Aged ; Radiography ; Reconstructive Surgical Procedures ; methods ; Spinal Neoplasms ; diagnostic imaging ; surgery ; Treatment Outcome ; Young Adult

Paraganglioma is a rare neuroendocrine neoplasm observed in patients of all ages, with an estimated incidence of 3/1,000,000 population. It has long been recognized that some cases are familial. The majority of these tumors are benign, and the only absolute criterion for malignancy is the presence of metastases at sites where chromaffin tissue is not usually found. Some tumors show gross local invasion and recurrence, which may indeed kill the patient, but this does not necessarily associate with metastatic potential. Here, we report a case of vertebral metastatic paraganglioma that occurred 19 months after the patient had undergone partial cystectomy for urinary bladder paraganglioma. We believe this to be a rarely reported bone metastasis of paraganglioma arising originally within the urinary bladder. In this report, we also provide a summary of the general characteristics of this disease, together with progress in diagnosis, treatment, and prognosis.
Chromogranin A ; metabolism ; Cystectomy ; Female ; Humans ; Middle Aged ; Paraganglioma ; metabolism ; pathology ; secondary ; surgery ; Phosphopyruvate Hydratase ; metabolism ; Prognosis ; Radionuclide Imaging ; Spinal Neoplasms ; diagnostic imaging ; secondary ; surgery ; Synaptophysin ; metabolism ; Technetium ; Thoracic Vertebrae ; Tomography, X-Ray Computed ; Urinary Bladder Neoplasms ; metabolism ; pathology ; surgery

Radiation-induced spinal cord gliomas are extremely rare. Since the first case was reported in 1980, only six additional cases have been reported.; The radiation-induced gliomas were related to the treatment of Hodgkin's lymphoma, thyroid cancer, and medullomyoblastoma, and to multiple chest fluoroscopic examinations in pulmonary tuberculosis patient. We report a case of radiation-induced spinal cord glioblastoma developed in a 17-year-old girl after a 13-year latency period following radiotherapy for nasopharyngeal rhabdomyosarcoma. MRI findings of our case are described.
Contrast Media/diagnostic use ; Female ; Gadolinium DTPA/diagnostic use ; Glioblastoma/*diagnosis/pathology/surgery ; Humans ; *Magnetic Resonance Imaging ; Nasopharyngeal Neoplasms/*radiotherapy ; Neoplasms, Radiation-Induced/*diagnosis/pathology ; Rhabdomyosarcoma/*radiotherapy ; Spinal Cord Neoplasms/*diagnosis/pathology/surgery

OBJECTIVETo investigate the clinical manifestation and surgical outcome of spinal osteoblastoma.

METHODSFrom June 2006 to July 2010, 11 patients with spinal osteoblastoma treated surgically were analyzed retrospectively. There were 7 males and 4 females with an average age of 23.5 years (range, 16 - 34 years). The tumors were located at C(5) in 3, C(6) in 4, C(7) in 2, C(6) ~ T(1) in 1 and T(11) in 1. Based on WBB classification, 9 were 1 - 3 or 10 - 12 and 2 were 4 - 9 and 1 - 3. All the operations had been performed with en-bloc resection. The posterior approach was used for 9 patients, and combined posterior and anterior approach was used for 2 patients. Reconstruction using instrumentation and fusion was performed using spinal instrumentation in 8 patients. To evaluate the change of pain before and after the operation by visual analogue scales (VAS), and to assess functional status of the spine by McCormick scale. Imaging test was used to review the stability and recurrence rate of spine cord, and the confluence of graft bones.

RESULTSAll cases were followed up for 12 - 64 months (average, 28.4 months). The average surgical time was 130.5 minutes (range, 90 - 210 minutes), with the average intraoperative blood loss of 560 ml (range, 300 - 1000 ml). During the follow-up period, the VAS grade reduced from 6.3 ± 1.1 to 2.5 ± 1.0 (t = 8.48, P < 0.05). There were 8 patients had neurological function improved and 3 remained no change which was evaluated by McCormick scale for spinal function status at final follow-up.

CONCLUSIONSSpinal osteoblastoma has its own specific radiographic feature. There are some recurrence in simple curettage of tumor lesion. The thoroughly en-bloc resection of tumor or spondylectomy, bone fusion and strong in ter fixation are the key points for successful surgical treatment.

Adolescent ; Adult ; Female ; Follow-Up Studies ; Humans ; Male ; Osteoblastoma ; diagnostic imaging ; surgery ; Pain Measurement ; Radiography ; Retrospective Studies ; Spinal Neoplasms ; pathology ; surgery ; Treatment Outcome ; Young Adult

OBJECTIVETo evaluate the safety and efficiency of hemi-semi laminectomy approach for the microsurgical treatment of spinal schwannomas.

METHODSA total of 22 patients underwent hemi-semi laminectomy for the microsurgical removal of spinal schwannomas during a period of 2009 and 2011 in Affiliated Hospital of Nantong University. We retrospectively analyzed the clinical outcomes of these patients.

RESULTSOf them, 5 cases were diagnosed with cervical schwannomas, 9 with thoracic schwannomas, and 8 with lumbar schwannomas. All the tumors including two dumbbell schwannomas were totally removed without major complications. Postoperatively, all patients were followed up from 6 to 36 months. The symptoms and signs were obviously improved, and no tumor recurrence or spinal deformity occurred.

CONCLUSIONHemi-semi laminectomy is a safe and effective method for resection of spinal schwannomas.

Adolescent ; Adult ; Aged ; Female ; Humans ; Laminectomy ; methods ; Magnetic Resonance Imaging ; Male ; Microsurgery ; methods ; Middle Aged ; Models, Biological ; Neurilemmoma ; diagnostic imaging ; surgery ; Radiography ; Retrospective Studies ; Spinal Cord Neoplasms ; diagnostic imaging ; surgery ; Treatment Outcome ; Young Adult