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).
- 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
- 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
- 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.
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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.