spinale Metastasen
Mammakarzinom
mit osteolytischen Metastasen: Magnetresonanztomographie der Wirbelsäule T1 nativ sagittal.
Mammakarzinom
mit osteolytischen Metastasen: Computertomographie der Wirbelsäule sagittal rekonstruiert Knochenfenster. Da die Patientin multiple Metastasen in allen Körperregionen hatte, konnte sie die Arme nicht für die Untersuchung nach oben nehmen und die Hände sind mit abgebildet.
Mammakarzinom
mit osteolytischen Metastasen: Computertomographie der Wirbelsäule sagittal rekonstruiert Weichteilfenster. Neben den Metastasen in der Wirbelsäule, die z.T. nach hinten in den Spinalkanal einwachsen, auch Metastasen im Sternum. Zusätzlich Lebermetastasen.
Mammakarzinom
mit osteolytischen Metastasen: Magnetresonanztomographie der Wirbelsäule T1 nativ sagittal. Beachte auch die Ausdehnung in den Bogenwurzeln.
Intradural
and intramedullary spinal metastases from lung neoplasm. Sagittal T2-weighted image shows multiple hyperintense nodular lesions in the spinal cord and nerve roots.
Intradural
and intramedullary spinal metastases from lung neoplasm. Axial T2-weighted image with metastasis nodules filling the thecal sac.
Intradural
and intramedullary spinal metastases from lung neoplasm. Sagittal contrast T1-weighted image shows multiple intradural extra and intramedullary enhancing metastasic nodules.
Spinal
metastases • Spinal metastases - spatial distribution - Ganzer Fall bei Radiopaedia
Intramedullary
spinal metastasis • Intramedullary spinal metastasis - Ganzer Fall bei Radiopaedia
Neoplasms of
the spinal canal • Spinal cord metastasis - Ganzer Fall bei Radiopaedia
Neoplasms of
the spinal canal • Leukemic infiltration of the spinal cord - Ganzer Fall bei Radiopaedia
Vertebral
metastases • Vertebral metastases - Ganzer Fall bei Radiopaedia
Spinal
metastases • Extra- and intradural spinal metastases from breast cancer - Ganzer Fall bei Radiopaedia
Intramedullary
spinal metastasis • Spinal cord metastasis - Ganzer Fall bei Radiopaedia
Intramedullary
spinal metastasis • Intramedullary spinal metastasis in small cell lung cancer - Ganzer Fall bei Radiopaedia
Bone up on
spinal osseous lesions: a case review series. Spinal metastases. Sagittal MR images demonstrate numerous ill-defined lesions throughout the lumbar spine (arrows). These lesions demonstrate low signal on the T1-weighted sequence (a), intermediate to high signal on the T2 -weighted sequence (b), and heterogenous contrast enhancement on the post-contrast T1 fat-saturated sequence (c)
Spinal metastases is a vague term which can be variably taken to refer to metastatic disease to any of the following:
- vertebral metastases (94%)
- may have epidural extension
- intradural extramedullary metastases (5%)
- intramedullary metastases (1%)
Each of these are discussed separately. Below are some general remarks on metastatic disease to the spine, theca and cord.
Epidemiology
Approximately 90% of all spinal (cord + vertebral) neoplasms are considered metastatic in origin.
Clinical presentation
Presentation can be highly variable. Sudden onset development of the Brown-Sequard syndrome in patients with known metastatic cancer has been described as a presenting feature .
Pathology
Spread of malignant cells to the region is variable and includes:
- haematogenic: arterial or venous
- direct invasion: typically of paraspinal, retroperitoneal of pulmonary malignancies
- lymphatic: along the root sleeves
- subarachnoid: intracanalicular seeding of primary and secondary CNS neoplasms
As the vast majority of metastases to the region are to bone, this is reflected in the primaries which are encountered. Having said that breast cancer, lung cancer and melanoma are also relatively common sources of intradural disease.
Primaries include:
- breast: 22%
- lung: 15%
- prostate: 10%
- lymphoma: 10%
- kidney: 7%
- gastrointestinal tract: 5%
- melanoma: 4%
- unknown: 4%
- others: 24%
Differential diagnosis
For extradural lesions consider:
- spinal schwannoma/neurilemmoma
- spinal neurofibroma
- extradural cysts
- developmental
- acquired: degenerative, infectious, traumatic/iatrogenic
For intradural extramedullary lesions consider (see also leptomeningeal metastases):
- if diffuse (sugar coating)
- meningoradiculitis
- arachnoiditis
- if nodular (mostly at cauda equina)
- spinal meningioma
- spinal neurilemmoma/schwannoma
- leptomeningeal (pial) lipoma
- post-arachnoiditic adhesions
- drop metastases from CNS primaries
- ependymoma
- astrocytoma
- oligodendroglioma
- glioblastoma
- choroid plexus tumors
- germ cell tumors
- medulloblastoma (PNET)
For intradural intramedullary lesions consider:
- inflammatory lesions (transverse myelitis)
- developmental lesions (intramedullary lipoma, syringomyelia)
- primary spinal cord tumors
See also
Siehe auch:
- Myelonkompression
- Kompaktainsel
- Osteoid-Osteom
- Aneurysmatische Knochenzyste
- Ependymom
- Glioblastoma multiforme
- vertebrale Metastasen
- Transverse Myelitis
- Schwannom
- Oligodendrogliom
- Astrozytom
- Osteoblastom
- Hämangioblastom
- Medulloblastom
- neoplasms of the spinal canal
- chronisch adhäsive Arachnopathie
- spinale Schwannome
- Syringomyelie
- intradural extramedullary metastases
- spinal neurofibroma
- Vertebroplastie
- intraspinales Meningeom
- Tumoren des Plexus choroideus
- sugar coating
- neurilemmoma
- intramedullary metastases (spinal)
- Knochenmetastasen
- the winking owl sign
und weiter:
Assoziationen und Differentialdiagnosen zu spinale Metastasen:
intramedullary
metastases (spinal)
