PMC9043833_01
CT of case 1. (A) On admission. (B) On day 63. The osteolytic metastasis in the spinous process of the 11th thoracic vertebra became larger.
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ADL gradually improved. Although the metastasis in the 11th thoracic vertebra increased during hospitalization (Fig. 2), he had no pain or paralysis.
PMC9043833_02
CT of case 2. (A) CT of 11th thoracic vertebra (Th11) on admission. (B) CT of 12th thoracic vertebra (Th12) on admission. (C) CT of pelvis on day 38. (D) CT of Th11 on day 58. (E) CT of Th12 on day 58. (F) CT of pelvis on day 58. CT on day 58 showed that the bone metastases on the right acetabulum and vertebrae had increased in size.
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However, he developed paralysis of the left leg because of a compression fracture in the 11th thoracic vertebra and malignant spinal cord compression (MSCC), leading to thoracolumbar laminectomy and fusion surgery 1 month prior to admission (Fig. 3A,B). On day 38, a new bone metastasis in the right acetabulum was detected by computed tomography (CT) (Fig. 3C). A CT scan on day 58 showed that the bone metastases on the right acetabulum and vertebrae had increased (Fig. 3D,E,F).
PMC9043833_03
CT of case 3. (A) CT of pelvis on admission. (B) CT of right tibia on day 22 (sagittal CT). (C) CT of pelvis on day 22. A new tumor was found in the tibia, and the pelvic tumor had become larger.
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Later, a new bone metastasis was found in the right iliac bone (Fig. 4A), but it was followed up. A CT scan on day 22 showed a new bone metastasis in his right tibia (Fig. 4B) and growth of other bone metastases (Fig. 4C).
PMC9043833_04
CT on admission of case 4. Multiple osteolytic bone metastases can be observed.
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CT at admission showed multiple osteolytic bone metastases in the acetabulum and whole vertebrae, including the second and third cervical vertebrae (Fig. 5).
PMC9043833_05
Pre-operative magnetic resonance imaging of case 5. Bone metastases and spinal cord compression in the sixth, eighth, and ninth thoracic vertebrae are visible. (A) T1-weighted image. (B) T2-weighted image.
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This led to his admission to an acute care hospital, where he was diagnosed with prostate cancer with metastases in the sixth, eighth, and ninth thoracic vertebrae (Fig. 6) and the third and fifth lumbar vertebrae, MSCC with bladder and rectal disturbance, and paralysis in both legs.
PMC9043833_06
(A) Pre-operative magnetic resonance imaging of case 6. T2-weighted image shows bone metastases and spinal cord compression in the 11th and 12th thoracic vertebrae. (B) X-Ray of case 6 after thoracic laminectomy and fusion surgery.
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He was admitted to an acute care hospital for chemotherapy 1 month prior to admission and thoracic vertebral metastases were detected (Fig. 7A). However, 2 weeks prior to admission, he developed numbness in both legs because of MSCC and underwent emergency thoracic laminectomy and fusion surgery (Fig. 7B).