Vertebral Body Thickened Bony Trabeculae

Lubdha M. Shah, MD

DIFFERENTIAL DIAGNOSIS

Common

Less Common

Rare but Important

ESSENTIAL INFORMATION

Key Differential Diagnosis Issues

Helpful Clues for Common Diagnoses

Hemangioma
- Corduroy pattern of thickened trabeculae & intervening fat
- Aggressive lesions are characterized by epidural extent & cord compromise
- T1/T2 hyperintense
Paget Disease
- Coarsened & irregular bony trabecular pattern with cortical thickening
- Heterogeneous, predominantly hypointense on T1 & hyperintense on T2
- Vertebral expansion leads to varying degrees of spinal & neural foraminal stenosis
Osteoporosis
- Marrow heterogeneity with focal islands of red marrow & centers of fat
- Focal deposits of yellow marrow, esp. in posterior elements, around central venous channels, & adjacent to endplates

Helpful Clues for Less Common Diagnoses

Fibrous Dysplasia
- Ground-glass matrix in mildly expanded lesion of the neural arch > vertebral body
Plasmacytoma
- Originate in the vertebral body, although involvement of the posterior elements not uncommon
- Endplate fractures produce curvilinear low signal areas &/or cortical irregularities
  - Thickened cortical struts in expanded vertebral body, “mini brain”

Helpful Clues for Rare Diagnoses

Metastases, Blastic Osseous
- Vertebral body, esp. posterior cortex, & pedicle are involved
- Sclerotic lesions may be discrete & nodular, mottled, or diffusely increased density
- Hypointense on T1WI & T2WI
- Variable enhancement depending on degree of sclerosis
Lymphoma
- Bony lymphomatous involvement results from hematogenous spread (95%)
- Diffuse, mottled pattern with reduced signal on T1 & T2 sequences