Metastatic Vertebral Disease


Clinical History: 
This 56-year-old male with a history of renal cell carcinoma presented to his primary care physician complaining of intractable back pain for one week. The MR examination performed for further assessment is given.

Metastatic renal cell carcinoma involving the thoracic and lumbar vertebrae

MR technique:
MR images were acquired on a 1.5 T Siemens MR unit utilizing (A) sagittal pre-contrast spin echo T1-weighted (TR/TE 665/7.9ms, scan time 3:35 min:sec), (B) turbo spin echo T2-weighted (TR/TE 2520/71ms, scan time 3:16 min:sec), (C) axial pre-contrast spin echo T1-weighted (TR/TE 553/7.9ms, scan time 4:24 min:sec), (D)sagittal post contrast spin echo fat-suppressed T1-weighted sequences. The slice thickness was 4 mm in each instance.

Imaging Findings:
There is a near complete replacement of the L1 vertebral body with abnormally enhancing soft tissue and associated loss of L1 vertebral body height of at least 50%. This is manifest on the sagittal T1-weighted images as loss of normal marrow hyperintensity. Associated retropulsion of the posterior L1 vertebral body into the central spinal canal is present, which results in compromise of the central spinal canal in the AP dimension, best demonstrated on T2 and contrast-enhanced T1-weighted images. Enhancing soft tissue extends confluently into the pre- and paravertebral soft tissues of LA with contiguous involvement of the T12.