Vertebral Body, T1 Hyperintense Signal, Focal



Vertebral Body, T1 Hyperintense Signal, Focal


Kevin R. Moore, MD



DIFFERENTIAL DIAGNOSIS


Common



  • Normal Variant


  • Hemangioma


  • Degenerative Endplate Changes


  • Focal Fatty Marrow


  • Gadolinium Enhancement


Less Common



  • Paget Disease


  • Metastasis, Melanoma


Rare but Important



  • Vertebral Marrow Hemorrhage


ESSENTIAL INFORMATION


Key Differential Diagnosis Issues



  • Use fat saturation &/or STIR MR imaging to distinguish fat from other etiologies of T1 hyperintensity


Helpful Clues for Common Diagnoses



  • Normal Variant



    • Heterogeneous marrow signal related to interspersed normal fat and hematopoietic elements in vertebral body


  • Hemangioma



    • Benign vertebral body vascular tumor with hyperintense T1 signal intensity


    • Usually incidental lesion identified on imaging performed for unrelated reasons


  • Degenerative Endplate Changes



    • Type 1: Hypointense on T1WI, hyperintense on T2WI


    • Type 2: Hyperintense on T1WI, isointense on T2WI


    • Type 3: Hypointense on T1WI and T2WI


  • Focal Fatty Marrow



    • Discrete focus of T1 hyperintensity representing macroscopic collection of fat interspersed with cellular marrow elements


    • Suppresses on fat-saturated or STIR MR imaging


  • Gadolinium Enhancement



    • T1 shortening produces high T1 signal intensity


    • Chemical fat saturation or STIR MR imaging will not abolish T1 shortening (unlike fat)


Helpful Clues for Less Common Diagnoses



  • Paget Disease



    • Enlarged vertebra and neural arch with trabecular coarsening and cortical thickening


  • Metastasis, Melanoma



    • Melanotic metastases may demonstrate T1 hyperintensity on unenhanced T1WI MR

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Aug 7, 2016 | Posted by in NEUROLOGY | Comments Off on Vertebral Body, T1 Hyperintense Signal, Focal

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