"Vertebra Plana-Like" Lesion

Figs 1&2: Sagittal MR image (T1 post contrast) and coronal-reformatted CT image of the thoracic spine of a 14-year-old boy show complete collapse (arrows) of the mid thoracic vertebral body, preserved adjacent discs and enhancing soft tissues around the affected vertebral body extending into the epidural space (arrowheads).

Vertebra Plana

• Collapse of one vertebral body
• Normal adjacent intervertebral disks
• Height of the intervertebral space increased by at least 1/3 compared to normal
• Increased density of the collapsed vertebra

Etiology

• Strict criteria above apply to the diagnosis of eosinophilic granuloma, considered the most frequent benign lesion causing vertebra plana
• Other causes include: primary tumor (e.g. Ewing sarcoma, osteosarcoma, lymphoma), and metastasis, trauma and chronic osteomyelitis

Benign or Malignant?

• Clinical and radiographic course typically allows the physician to differentiate eosinophilic granuloma from other diagnoses that require diagnostic vertebral biopsy
• Using criteria based on studies of adult with compression fractures (differentiating benign from malignant compression fractures) may be helpful. The following MR findings were shown to be suggestive of malignancy: involvement of pedicle, irregular nodular paravertebral soft tissue lesion, marked and heterogeneous enhancement pattern.

Our case: metastatic round cell tumor to the spine causing "vertebra plana-like" appearance

References:
1. Baghaie M, Gillet P, Dondelinger RF, et al. Vertebra plana: benign or malignant lesion? Pediatr Radiol 1996;26:431-433.
2. Ippolito E, Farsetti P, Tudisco C. Vertebra plana. Long-term follow-up in five patients. J Bone Joint Surg Am 1984;66:1364-1368.
3. Shih TT, Huang K, Li Y. Solitary vertebral collapse: distinction between benign and malignant causes using MR patterns. J Magn Reson Imaging 1999;9:635-642.