PMC6735185_01
The preoperative thoracic magnetic resonance imaging (MRI) showed a minor intraspinal occupying-lesion and associated pathological fractures of the vertebrae. (a, b) The T1-weighted and T2-weighted images show the fractures of the thoracic vertebrae body. (c) The cross section shows a possibility of an intraspinal space-occupying lesion in the T4 level like the black arrow indicated.
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The preoperative thoracic magnetic resonance imaging (MRI) showed a minor intraspinal space-occupying lesion in the fourth thoracic vertebra canal and found pathological fractures of the fourth vertebrae (Figure 1).
(a, b) The regular films of X-ray about the thoracic vertebrae show bone cement plus 125I seeds in the T4 body. Black arrow indicates the location of 125I seeds close to the back wall of the vertebra.
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And then, he accepted the percutaneous vertebroplasty (PVP) plus interstitial implantation of 125I particles (10 particles) at a local county hospital (Figure 2). Notably, there are several particles located in the vertebral posterior wall without appropriate distribution (Figure 2).
(a) The postoperative CT shows bone cements and metallic implants in T4 without any leakage in the T4 vertebrae body. (b) The postoperative MRI shows a larger intraspinal space-occupying lesion in the T4 intraspinal level. (c) The enhanced CT indicated the possibility of tissue tumor. The blue arrow and red arrow indicate the possibility of tissue tumor or hematoma.
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The postoperative transverse computed tomography (CT) revealed bone cements and metallic implants in T4 without any bone cement leakage, but the MRI showed the left intraspinal space-occupying lesion in the T4 vertebral body (Figure 3). And the enhanced CT indicated the possibility of tissue tumor, which was also confirmed by thoracic vertebra magnetic resonance imaging (Figure 3).
(a, b) Photograph of the tissues of intraspinal space-occupying lesion and are H&E x100 pictures. These show that the fiber tissues keep their normal shape without any discovery of tumor cells.
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However, no powerful evidences could be used to confirm that the intraspinal space-occupying lesion was a tissue tumor (Figure 4).
(a) T1-weighted image shows that the T4 body was filled with PMMA and 125I seeds. (b-d) The high signal intensity of the spinal cord in T2-weighted and fat-suppression images in the T5 level. The white arrow shows the high signal intensity of the spinal cord.
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In fact, the results of MRI showed the high signal intensity in T2-weighted and fat-suppression images in the T5 body level (Figure 5).