PMC4861890_01
49-year-old male with thoracic spine mass. Findings: AP and lateral radiographs are unremarkable, with the exception of mild degenerative changes.
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Initial radiographic survey of the thoracic spine was unremarkable, with the exception of mild degenerative changes (Fig. 1).
49-year-old male with thoracic spine mass. Sagittal T1, T2, axial T2, sagittal, and axial fat-saturated postcontrast, B-1000 weighted DWI images, and ADC map of the thoracic spine demonstrate a T1 hypointense, T2 hyperintense, avidly enhancing mass with mildly restricted diffusion extending through the T6-T7 posterolateral epidural space into the left neural foramina. There is involvement of the left transverse process of T6 and superior facet of T7. Blue arrows denote the epidural component. Red arrows denote the intraosseous component.
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T6-T7 epidural space (Fig. 2).
49-year-old male with thoracic spine mass. Status: Postsurgical resection and radiation therapy. Axial T1, T2, T1fat-saturated postcontrast, sagittal T1, and sagittal T1 fat-saturated postcontrast images of the thoracic spine demonstrate reduced epidural and osseous enhancing residual tumor and posttreatment changes in the adjacent tissue. Blue arrow denotes epidural mass extending through the left neural foramina. Red arrow denotes the intraosseous tumor.
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Followup MRI imaging (Fig. 3) demonstrated residual intra- and extraosseous masslike enhancement, which was stable from an immediate postoperative exam.
PMC4861890_02
50-year-old male patient presenting with chest tightness. Status: postsurgical resection and radiation therapy. Axial T1, T2, T1 fat-saturated postcontrast, sagittal T1, and sagittal T1 fat-saturated postcontrast images of the thoracic spine demonstrate reduced epidural and osseous enhancing residual tumor and post-treatment changes in the adjacent tissue. Blue arrow denotes epidural mass extending through the left neural foramina. Red arrow denotes the intraosseous tumor.
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Initial MRI demonstrated an expansile osseous mass with a well-demarcated lobular margin involving the left transverse process, pedicle, and spinous process of T3 (Fig. 4).
50-year-old male patient presenting with chest tightness. Axial and sagittal postcontrast CT of the thoracic spine in soft tissue and bone windows demonstrate the expansile mass arising from the posterior elements of T3, with extraosseous component involving the dorsal epidural space. The mass has avid enhancement at the epidural portion and subtle globular foci of low-density and high-density septations. Blue arrows denote the intraosseous mass. Red arrows denote the epidural component.
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On contrast-enhanced CT, the tumor demonstrated generally homogeneous enhancement of the epidural portion with focal areas of hypo-attenuation (Fig. 5).
50-year-old male patient presenting with thoracic spine mass. Axial noncontrast CT of the thoracic spine for CT-guided biopsy again demonstrates that the T3 mass has irregular indistinct zone of transition with a weakly sclerotic margin and multiple internal septae. The expansile portion of the spinous process was targeted.
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Subsequent CT-guided biopsy produced a nondiagnostic sample containing only blood elements (Fig. 6).
50-year-old male presenting with thoracic spine mass. Status: post thoracic resection and radiation therapy. Sagittal T1, T2, axial T1, and sagittal and axial T1 fat-saturated postcontrast images of the thoracic spine demonstrate residual epidural enhancing tumor with post-treatment changes in the adjacent tissues. Blue arrow denotes the residual mass.
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Postoperative imaging demonstrated post-treatment bed enhancement without discrete mass or new destructive changes (Fig. 7).