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Spine
Diagnosis
Neoplasms, Cysts, and Other Masses
Neoplasms
Extradural
Blastic Osseous Metastases
Blastic Osseous Metastases
Jeffrey S. Ross, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            TERMINOLOGY

            • Synonyms

              • Sclerotic metastases, osteosclerotic metastases, osteoblastic metastases

            • Definitions

              • Spread of primary tumor to spine where bone production exceeds bone destruction

            IMAGING

            • General Features

              • Radiographic Findings

                • CT Findings

                  • MR Findings

                    • Nuclear Medicine Findings

                      • Imaging Recommendations

                        DIFFERENTIAL DIAGNOSIS

                          PATHOLOGY

                          • General Features

                            • Staging, Grading, & Classification

                              • Gross Pathologic & Surgical Features

                                • Microscopic Features

                                  CLINICAL ISSUES

                                  • Presentation

                                    • Demographics

                                      • Natural History & Prognosis

                                        • Treatment

                                          DIAGNOSTIC CHECKLIST

                                          • Consider

                                            • Image Interpretation Pearls

                                              Selected References

                                              1. Cornelis FH et al: Percutaneous image-guided electrochemotherapy of spine metastases: initial experience. Cardiovasc Intervent Radiol. 42(12):1806-9, 2019
                                              2. Pennington Z et al: SINS score and stability: evaluating the need for stabilization within the uncertain category. World Neurosurg. 128:e1034-47, 2019
                                              3. Hussain I et al: Patient-reported outcomes after surgical stabilization of spinal tumors: symptom-based validation of the Spinal Instability Neoplastic Score (SINS) and surgery. Spine J. 18(2):261-7, 2018
                                              4. Shi DD et al: Assessing the utility of the spinal instability neoplastic score (SINS) to predict fracture after conventional radiation therapy (RT) for spinal metastases. Pract Radiat Oncol. 8(5):e285-94, 2018
                                              5. Macedo F et al: Bone metastases: an overview. Oncol Rev. 11(1):321, 2017
                                              6. Dushyanthen S et al: The osteoblastic and osteoclastic interactions in spinal metastases secondary to prostate cancer. Cancer Growth Metastasis. 6:61-80, 2013
                                              7. Goudarzi B et al: Detection of bone metastases using diffusion weighted magnetic resonance imaging: comparison with (11)C-methionine PET and bone scintigraphy. Magn Reson Imaging. 28(3):372-9, 2010
                                              8. Borad MJ et al: Skeletal metastases in pancreatic cancer: a retrospective study and review of the literature. Yale J Biol Med. 82(1):1-6, 2009
                                              9. Oztekin O et al: SSH-EPI diffusion-weighted MR imaging of the spine with low b values: is it useful in differentiating malignant metastatic tumor infiltration from benign fracture edema? Skeletal Radiol. 38(7):651-8, 2009
                                              10. Israel O et al: FDG-PET and CT patterns of bone metastases and their relationship to previously administered anti-cancer therapy. Eur J Nucl Med Mol Imaging. 33(11):1280-4, 2006
                                              11. Fogelman I et al: Positron emission tomography and bone metastases. Semin Nucl Med. 35(2):135-42, 2005
                                              12. Nakai T et al: Pitfalls of FDG-PET for the diagnosis of osteoblastic bone metastases in patients with breast cancer. Eur J Nucl Med Mol Imaging. 32(11):1253-8, 2005
                                              13. Tomita K et al: Surgical strategy for spinal metastases. Spine. 26(3):298-306, 2001
                                              14. Wahl RL: Current status of PET in breast cancer imaging, staging, and therapy. Semin Roentgenol. 36(3):250-60, 2001
                                              15. Castillo M et al: Diffusion-weighted MR imaging offers no advantage over routine noncontrast MR imaging in the detection of vertebral metastases. AJNR Am J Neuroradiol. 21(5):948-53, 2000
                                              16. Chamberlain MC et al: Epidural spinal cord compression: a single institution's retrospective experience. Neuro Oncol. 1(2):120-3, 1999
                                              17. Vanel D et al: MRI of bone metastases. Eur Radiol. 8(8):1345-51, 1998
                                              18. Ontell FK et al: Blastic osseous metastases in ovarian carcinoma. Can Assoc Radiol J. 46(3):231-4, 1995
                                              19. Olson EM et al: Osseous metastasis in medulloblastoma: MRI findings in an unusual case. Clin Imaging. 15(4):286-9, 1991
                                              20. Thrall JH et al: Skeletal metastases. Radiol Clin North Am. 25(6):1155-70, 1987
                                              21. Aoki J et al: Sclerotic bone metastasis: radiologic-pathologic correlation. Radiology. 159(1):127-32, 1986
                                              22. Galasko CS: Mechanisms of lytic and blastic metastatic disease of bone. Clin Orthop. (169):20-7, 1982
                                              23. Joffe N et al: Osteoblastic bone metastases secondary to adenocarcinoma of the pancreas. Clin Radiol. 29(1):41-6, 1978
                                              24. Kongtawng T et al: Radiographic evaluation of treatment of advanced carcinoma of the prostate. South Med J. 71(3):247-50, 1978
                                              25. Lokich JJ: Osseous metastases: radiographic monitoring of therapeutic response. Oncology. 35(6):274-6, 1978
                                              Related Anatomy
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                                              Related Differential Diagnoses
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                                              References
                                              Tables

                                              Tables

                                              KEY FACTS

                                              • Terminology

                                                • Imaging

                                                  • Top Differential Diagnoses

                                                    • Pathology

                                                      • Clinical Issues

                                                        TERMINOLOGY

                                                        • Synonyms

                                                          • Sclerotic metastases, osteosclerotic metastases, osteoblastic metastases

                                                        • Definitions

                                                          • Spread of primary tumor to spine where bone production exceeds bone destruction

                                                        IMAGING

                                                        • General Features

                                                          • Radiographic Findings

                                                            • CT Findings

                                                              • MR Findings

                                                                • Nuclear Medicine Findings

                                                                  • Imaging Recommendations

                                                                    DIFFERENTIAL DIAGNOSIS

                                                                      PATHOLOGY

                                                                      • General Features

                                                                        • Staging, Grading, & Classification

                                                                          • Gross Pathologic & Surgical Features

                                                                            • Microscopic Features

                                                                              CLINICAL ISSUES

                                                                              • Presentation

                                                                                • Demographics

                                                                                  • Natural History & Prognosis

                                                                                    • Treatment

                                                                                      DIAGNOSTIC CHECKLIST

                                                                                      • Consider

                                                                                        • Image Interpretation Pearls

                                                                                          Selected References

                                                                                          1. Cornelis FH et al: Percutaneous image-guided electrochemotherapy of spine metastases: initial experience. Cardiovasc Intervent Radiol. 42(12):1806-9, 2019
                                                                                          2. Pennington Z et al: SINS score and stability: evaluating the need for stabilization within the uncertain category. World Neurosurg. 128:e1034-47, 2019
                                                                                          3. Hussain I et al: Patient-reported outcomes after surgical stabilization of spinal tumors: symptom-based validation of the Spinal Instability Neoplastic Score (SINS) and surgery. Spine J. 18(2):261-7, 2018
                                                                                          4. Shi DD et al: Assessing the utility of the spinal instability neoplastic score (SINS) to predict fracture after conventional radiation therapy (RT) for spinal metastases. Pract Radiat Oncol. 8(5):e285-94, 2018
                                                                                          5. Macedo F et al: Bone metastases: an overview. Oncol Rev. 11(1):321, 2017
                                                                                          6. Dushyanthen S et al: The osteoblastic and osteoclastic interactions in spinal metastases secondary to prostate cancer. Cancer Growth Metastasis. 6:61-80, 2013
                                                                                          7. Goudarzi B et al: Detection of bone metastases using diffusion weighted magnetic resonance imaging: comparison with (11)C-methionine PET and bone scintigraphy. Magn Reson Imaging. 28(3):372-9, 2010
                                                                                          8. Borad MJ et al: Skeletal metastases in pancreatic cancer: a retrospective study and review of the literature. Yale J Biol Med. 82(1):1-6, 2009
                                                                                          9. Oztekin O et al: SSH-EPI diffusion-weighted MR imaging of the spine with low b values: is it useful in differentiating malignant metastatic tumor infiltration from benign fracture edema? Skeletal Radiol. 38(7):651-8, 2009
                                                                                          10. Israel O et al: FDG-PET and CT patterns of bone metastases and their relationship to previously administered anti-cancer therapy. Eur J Nucl Med Mol Imaging. 33(11):1280-4, 2006
                                                                                          11. Fogelman I et al: Positron emission tomography and bone metastases. Semin Nucl Med. 35(2):135-42, 2005
                                                                                          12. Nakai T et al: Pitfalls of FDG-PET for the diagnosis of osteoblastic bone metastases in patients with breast cancer. Eur J Nucl Med Mol Imaging. 32(11):1253-8, 2005
                                                                                          13. Tomita K et al: Surgical strategy for spinal metastases. Spine. 26(3):298-306, 2001
                                                                                          14. Wahl RL: Current status of PET in breast cancer imaging, staging, and therapy. Semin Roentgenol. 36(3):250-60, 2001
                                                                                          15. Castillo M et al: Diffusion-weighted MR imaging offers no advantage over routine noncontrast MR imaging in the detection of vertebral metastases. AJNR Am J Neuroradiol. 21(5):948-53, 2000
                                                                                          16. Chamberlain MC et al: Epidural spinal cord compression: a single institution's retrospective experience. Neuro Oncol. 1(2):120-3, 1999
                                                                                          17. Vanel D et al: MRI of bone metastases. Eur Radiol. 8(8):1345-51, 1998
                                                                                          18. Ontell FK et al: Blastic osseous metastases in ovarian carcinoma. Can Assoc Radiol J. 46(3):231-4, 1995
                                                                                          19. Olson EM et al: Osseous metastasis in medulloblastoma: MRI findings in an unusual case. Clin Imaging. 15(4):286-9, 1991
                                                                                          20. Thrall JH et al: Skeletal metastases. Radiol Clin North Am. 25(6):1155-70, 1987
                                                                                          21. Aoki J et al: Sclerotic bone metastasis: radiologic-pathologic correlation. Radiology. 159(1):127-32, 1986
                                                                                          22. Galasko CS: Mechanisms of lytic and blastic metastatic disease of bone. Clin Orthop. (169):20-7, 1982
                                                                                          23. Joffe N et al: Osteoblastic bone metastases secondary to adenocarcinoma of the pancreas. Clin Radiol. 29(1):41-6, 1978
                                                                                          24. Kongtawng T et al: Radiographic evaluation of treatment of advanced carcinoma of the prostate. South Med J. 71(3):247-50, 1978
                                                                                          25. Lokich JJ: Osseous metastases: radiographic monitoring of therapeutic response. Oncology. 35(6):274-6, 1978