E5061. All Is Not as It Seems: A Case Review of Malignancy Mimics in the Spine
  1. Grant Zomermaand; University of Nebraska Medical Center
  2. Harvey Sekhon; University of Nebraska Medical Center
  3. John Haas; University of Nebraska Medical Center
  4. Sean Kelly; University of Nebraska Medical Center
  5. Mark Keiper; University of Nebraska Medical Center
Radiologists frequently encounter indeterminate lesions in the spine, many of which are encountered incidentally. Though it is crucial that radiologists know the imaging features concerning for malignancy, it is important to know that not all suspicious lesions are malignant. Within the spine, there are many benign lesions with imaging characteristics that understandably could be mistaken for malignancy. Having awareness of these could help to expand the differential and potentially avoid unnecessary surgical intervention.

Educational Goals / Teaching Points
The goals of this presentation are to bring awareness to disease processes that mimic malignancy in the spine and to elicit imaging features that could help to differentiate benign from malignant etiologies. In many cases, radiologists are unable to achieve diagnostic certainty, and biopsy may still be required for confirmation.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
This presentation will highlight examples of spine lesions we have encountered at our tertiary care center that presented as malignant mimics. Clinical history, indications for imaging, and annotated images (including CT, MRI, and other modalities) will be included. This will be followed by brief discussions of appropriate differential diagnoses, clues to distinguish and narrow the differential, and possible limitations to differentiating certain etiologies by imaging. Some example spinal malignancy mimics we plan to incorporate into our exhibit include osseous sarcoidosis, Paget disease, amyloidosis, calcium pyrophosphate dihydrate deposition disease, vascular lesions, such an aggressive hemangioma and prominent vertebral enhancement secondary to central venous occlusion and venous congestion, and a large synovial cyst mimicking a cystic neoplasm, among other common and uncommon inflammatory, metabolic, and infectious processes.

After reviewing this presentation, the viewer will have a better understanding of how to differentiate spinal lesions of various pathologies that may mimic malignancy. The ability to expand and narrow the differential when appropriate could have profound effects on timely diagnosis, appropriate triage, and effective treatment. In doing so, radiologists can help alleviate patient anxiety and assist clinicians in improving patient outcomes.