J Caleb Richards MD Faculty reviewer Scott Serlin MD University of Texas Medical School at Houston Date accepted 9 February 2014 Radiological Category Principal Modality Neuro ID: 1043256
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1. Case Report 01006Submitted by:J. Caleb Richards, M.D.Faculty reviewer:Scott Serlin, M.DUniversity of Texas Medical School at HoustonDate accepted:9 February 2014Radiological Category:Principal Modality: NeuroCT
2. Case History13 year old male with back pain
3. CT
4. CT
5. Involvement of the posterior elements Blastic lesion Lytic lesionWhich features are present?Test Your Diagnosis
6. FindingsCT shows an expansile, lytic lesion involving the posterior elements of C3, specifically the lamina and spinous processThe lesion has well defined margins with osteoid matrix deposition
7. MRT1STIR
8. MRPost ContrastPost Contrast
9. Cord compression Cord transection Cord hematomaWhich features are present?Test Your Diagnosis
10. Osteoblastoma Spondylodiscitis HemangiomaWhat is the most likely diagnosis?Test Your Diagnosis
11. FindingsMR shows enhancement of the expansile lesion involving the posterior elements of C3There is obliteration of CSF space at this level with increased cord signal on T2WI consistent with cord compressionIncreased T2 signal and enhancement of the adjacent paraspinal soft tissues is secondary to inflammation T1STIRPost Contrast
12. OsteoblastomaBenign osteoid producing tumor, differentiated from osteoid osteoma grossly by size > 1.5 cm90% occur within 2nd-3rd decadeCan present with dull, aching back pain, painful scoliosis, or neurologic symptoms if nerve or cord compressionRadiographic findings include an expansile, lytic lesion with osteoid matrix production with predilection for the posterior elementsDue to prostaglandin release, can have inflammatory response of the adjacent soft tissues, mimicking infection or malignancyNarrow zone of transition with sclerotic rimTreatment is curretage with bone graft or methylmethacrylate placementDifferential diagnosis: osteoid osteoma, chordoma, aneurysmal bone cyst, metastasisDiscussion
13. Osteoblastoma Diagnosis
14. ReferencesChew, F et al. Cervical Spine Osteoblastoma. AJR 1998;171:1Shaikh, M et al. Spinal osteoblastoma: CT and MR imaging with pathological correlation. Skeletal Radiology. January 1999, Volume 28, Issue 1, 33-40