ARRS 2022 Abstracts


E1333. Wrap-Around Sign in Non-Hodgkin Lymphoma of the Spine: A Common Yet Overlooked Imaging Feature
  1. Tomas Marek; Department of Neurosurgery, Mayo Clinic; Department of Radiology, UF College of Medicine – Jacksonville
  2. Christopher Hunt; Department of Radiology, Mayo Clinic
  3. Benjamin Howe; Department of Radiology, Mayo Clinic
  4. Robert Spinner; Department of Neurosurgery, Mayo Clinic
Anecdotal cases of the so-called “wrap-around” appearance in non-Hodgkin lymphoma (NHL) of the spine exist in the medical literature. This imaging feature is characterized by a vertebra circumferentially encased by a lymphoma mass. Although several case reports and small series of this sign exist, there is a lack of larger studies looking at the prevalence of this imaging feature. For this reason, we conducted a retrospective review of our institutional cases to evaluate this feature's prevalence.

Materials and Methods:
We screened our institutional database for biopsy-proven NHL. Our inclusion criteria were the histologically confirmed diagnosis of NHL involving any vertebra, available MRI of the affected site, and a positive wrap-around sign. Exclusion criteria included lymphoma cases without the wrap-around sign and/or histology other than NHL. We subdivided the cases into three groups: 1) lymphoma wrapped around the vertebral body; 2) the posterior elements alone; or 3) both the vertebral body and posterior elements.

Our search identified 147 cases of NHL in which a confirmatory biopsy at the primary tumor site was available. Of those, 23 cases fulfilled the inclusion criteria (16 men and 7 women with average age at diagnosis of 63.3 years), yielding prevalence of 15.6% in our series. Most commonly, the lymphoma involved the vertebral body with or without some involvement of the posterior vertebral elements (n = 20, 86.9%), followed by posterior vertebral elements (n = 2, 8.7%). One remaining case (4.4%) had lymphoma involving the anterior vertebral body and posterior elements.

The wrap-around sign in cases of NHLs seems to be under-recognized and underappreciated. A similar pattern of bone marrow and soft-tissue tumor involvement without significant osseous destruction can be seen in NHL of the long bones. This sign can be helpful in diagnosis of NHL of the spinal column. HLs might demonstrate similar features; however, bone destruction may be the more prominent feature. Larger studies are necessary to get more precise information about the prevalence of the wrap-around sign.