|
Year |
2002 |
|---|---|
|
Question Number |
41. |
|
Category |
Orthopaedic Disease |
Question
Figures 6a-6c show the plain radiographs, MRI scan, and bone scan of an 80 y/o woman. These findings are most consistent with a diagnosis of
1. metastatic carcinoma.
2. compression fracture.
3. osteomyelitis.
4. tuberculosis.
5. Paget’s disease.
Figures
Answer (click for answer)
Preferred answer: 2
Discussion:
This question sucks!! The X-ray is not bad and demonstrates that there is loss of anterior height to the thoracic vertebral body. The MRI is a piece of CRAP!! My reading of the MRI is that there is loss of signal intensity in the anterior 2/3 of the body with preserved marrow signal in the posterior third. The end-plates appear intact and there is slight involvement of the disc space superiorly. However it is only on view and there is NO T2 image to compare with the T1 image. The bone scan shows a "hot" lesion in the thoracic spine.
This table is better at explaining why #2 is right than I can do. I suggest you read this article and tell me where I can go.
Reference: Vaccaro AR, Shah SH, Schweitzer ME, Rosenfelk JF, Cotler JF: MRI description of vertebral osteomyelitis, neoplasm, and compression fracture. Orthopedics 1999;22;67-73.