Vertebral Body, T1 Hypointense Signal, Focal
Bryson Borg, MD
DIFFERENTIAL DIAGNOSIS
Common
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Basivertebral Vein
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Schmorl Node
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Bone Island
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Hemangioma (Atypical)
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Fracture
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Surgical Material
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Metallic Hardware
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Bone Cement
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Osteomyelitis, Pyogenic
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Osteomyelitis, Granulomatous
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Degenerative Endplate Change (Types 1 & 3)
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Metastases
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Multiple Myeloma
Less Common
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Limbus Vertebra
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Kümmell Disease
Rare but Important
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Vertebral Pneumatocyst
ESSENTIAL INFORMATION
Helpful Clues for Diagnoses
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Basivertebral Vein
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Linear or triangular structure projecting ventrally from the center of the posterior body
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Schmorl Node
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Hypointense T1, variably hyperintense T2, circumscribed vertebral body lesion
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In continuity with an adjacent disc space
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Bone Island
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Focal sclerotic lesion, markedly hypointense on all sequences, with normal marrow signal elsewhere
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CT may be useful to confirm diagnosis
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Hemangioma (Atypical)
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Some lipid-poor hemangiomas are isointense or hypointense to marrow on T1WI
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Bone algorithm CT can assess for characteristic bony features (thickened vertical trabeculae)
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Fracture
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Fracture line often difficult to delineate on MR
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Associated marrow edema hypointense on T1WI
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Osteomyelitis, Pyogenic
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Hypointense T1 marrow signal adjacent to the level of infection
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Metastases
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Nearly all metastases hypointense on T1WI, whether blastic or lytic
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Multiple lesions typical
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Limbus Vertebra
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Unfused fragment of the ring apophysis, usually anterosuperior vertebral margin
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Mid-lumbar most common
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Kümmell Disease
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Post-traumatic osteonecrosis
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Horizontal, gas-filled intravertebral cleft is a characteristic finding; appears as signal void on MR
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