Pseudopathologic Vertebral Marrow Enhancement Mimicking Osseous Metastases

Sartaaj Walia, Suyash Mohan, Robert M. Kurtz, Lee P. Hartner and Arun C. Nachiappan


Pseudopathologic vertebral marrow enhancement mimicking osseous metastases is rare. We report a case of a 63-year-old woman with retroperitoneal liposarcoma who presented with waxing and waning sclerotic appearing lesions in the cervicothoracic spine on CT, which resembled osseous metastases. Extensive review of multiple prior exams and protocols demonstrated that the sclerotic lesions were only apparent on CT exams that utilized injection of contrast via the left upper extremity, and these exams also demonstrated collateral contrast opacification of the vertebral venous plexus that was not otherwise visualized. This unusual pattern of enhancement suggested a vascular etiology was more likely to explain the imaging findings. Attention to the vasculature demonstrated hemodynamically significant left brachiocephalic vein stenosis, possibly related to the patient’s chest port catheter placed via the left internal jugular vein. Analysis of in-phase and opposed-phase signal differences using paired gradient echo sequences on MR cervical spine demonstrated significant signal drop out within the osseous lesions. These signal intensity findings more likely reflect a benign process rather than the marrow replacement seen in malignant lesions. The diagnosis was determined to be benign vertebral marrow enhancement related to venous collaterals in the setting of central venous stenosis.

Published on: June 26, 2023
doi: 10.17756/micr.2023-091
Citation:  Walia S, Mohan S, Kurtz RM, Hartner LP, Nachiappan AC. 2023. Pseudopathologic Vertebral Marrow Enhancement Mimicking Osseous Metastases. J Med Imaging Case Rep 7(1): 26-28.