CASE 1555 Published on 15.08.2002

Vertebral sarcoidosis

Section

Musculoskeletal system

Case Type

Clinical Cases

Authors

B. Taouli, E. Dion, P.A. Grenier

Patient

38 years, female

Categories

No Area of Interest ; Imaging Technique MR, CT, CT

No Procedure ; No Special Focus ;

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Clinical History

The patient presented with fever, weight loss and back pain. There was no known history of cancer. X-rays of the spine were normal. Increased vertebral uptake was seen on bone scintigraphy.

Imaging Findings

The patient presented with fever, weight loss and back pain. There was no known history of cancer. X-rays of the spine were normal. Increased vertebral uptake was seen on bone scintigraphy.

On CT examination multiple thoracic and lumbar vertebral lytic- and sclerotic-appearing lesions were seen. On MRI multiple cervical and thoracolumbar lesions were sdemonstrated (hypointense on T1-weighted images and slightly hyperintense on T2-weighted images) with surrounding bright signal (probably corresponding to oedema) visible around some lesions. No vertebral fracture was visible, and no disk involvement. The epidural space and soft tissues were spared.

Helical chest CT showed mediastinal and bilateral lymph nodes enlargement, thickening of the peribronchovascular bundles, and parenchymal nodules in a peribronchovascular distribution.

Discussion

Sarcoidosis is a multisystem disease characterised by non-caseating granulomas involving essentially the lungs, spleen and lymph nodes. Bone involvement is rare in sarcoidosis, occuring in 1-10% of cases, usually involving the peripheral skeleton. Vertebral involvement has been described in a dozen case reports.

Vertebral lesions usually appear as lytic lesions with sclerotic margins involving the vertebral body and the pedicles (hypointense on T1-weighted images, hyperintense on T2-weighted images). The disk is almost never involved (except in one case report, Kenney et al.). As in our case, a vertebral biopsy is necessary to exclude alternative diagnoses, such as tuberculosis, before initiating steroid therapy. Chest CT is useful to look for associated lymph nodes and parenchymal involvement.

Differential Diagnosis List

Multifocal vertebral sarcoidosis

Final Diagnosis

Multifocal vertebral sarcoidosis

References

[1] Fisher AJ, Gilula LA, Kyriakos M, Holzaepfel CD. MR imaging changes of lumbar vertebral sarcoidosis. AJR Am J Roentgenol. 1999 Aug;173(2):354-6. (PMID: 10430135)

[2] Ginsberg LE, Williams DW 3rd, Stanton C. MRI of vertebral sarcoidosis. J Comput Assist Tomogr. 1993 Jan-Feb;17(1):158-9. (PMID: 8419430)

[3] Golzarian J, Matos C, Golstein M, Stallenberg B, Depierreux M, Struyven J. Case report: Osteosclerotic sarcoidosis of spine and pelvis: plain film and magnetic resonance imaging findings. Br J Radiol. 1994 Apr;67(796):401-4. (PMID: 8173885)

[4] Jelinek JS, Mark AS, Barth WF. Sclerotic lesions of the cervical spine in sarcoidosis. Skeletal Radiol. 1998 Dec;27(12):702-4. (PMID: 9921934)

[5] Kenney CM 3rd, Goldstein SJ. MRI of sarcoid spondylodiskitis. J Comput Assist Tomogr. 1992 Jul-Aug;16(4):660-2. (PMID: 1629432)

Case information

URL:	https://www.eurorad.org/case/1555
DOI:	10.1594/EURORAD/CASE.1555
ISSN:	1563-4086

Figure 1

Thoracolumbar MRI

The sagittal T1-weighted image shows the presence of multiple hypointense lesions located within the vertebral bodies (Eur Radiol 2002;11:F1-F14).

The sagittal T2-weighted image shows that the vertebral lesions are hyperintense, with the presence of a rim of high signal (probably corresponding to edema) around some of the lesions. (Eur Radiol 2002;11:F1-F14)

The sagittal T1-weighted image after gadolinium injection shows strong enhancement of the lesions. In addition, there are no vertebral fractures and no disk involvement. The epidural space and soft tissues are spared. (Eur Radiol 2002;11:F1-F14)

Figure 2

Total spine CT

Transverse CT image at the level of L3 shows the presence of two different lesions of the vertebral body: the anterior lesion has a lytic and sclerotic appearance, and the posterior lesion is purely lytic. (Eur Radiol 2002;11:F1-F14).

Transverse CT image of the sacrum shows the presence of multiple lytic lesions with a sclerotic rim. (Eur Radiol 2002;11:F1-F14)

Figure 3

Spiral unenhanced chest CT

The transverse chest CT scan image (mediastinal windows) shows bilateral enlargement of mediastinal and hilar lymph nodes. (Eur Radiol 2002;11:F1-F14)

Transverse chest CT scan image (lung windows) shows thickening of the peribronchovascular bundles, and parenchymal nodules in a peribronchovascular distribution. (Eur Radiol 2002;11:F1-F14)