Pathologic Fractures Radsource. Clinical History A 5. Stage 3. A breast cancer presents to her family physician with back pain. A radiograph reveals a severe L1 compression fracture. Hgs0jJ5DTgGb3Uo4Dmcoikvi6iEejXm.jpg' alt='Reson 6 Only Democracy' title='Reson 6 Only Democracy' />She is referred to an orthopaedist. On physical exam she exhibits axial type pain without radicular symptoms or myelopathic signs. Concern for possible osseous metastasis to the spine results in performance of an MRI. More fun with neodymium magnets. Neodymium Iron Boron NIB magnets are extremely powerful, and allow effects to be seen that arent possible with normal iron or. John McFerrin reviews the wonderful late 60s psychedelic band, The Doors. T1, T2, and fat suppressed T2 weighted sagittal images, a 1d T1 weighted axial image, and a 1e fat suppressed T1 weighted sagittal image following contrast administration are provided. What are the findingsReson 6 Only DemonWhat is your diagnosis Figure 1 1a c T1, T2, and fat suppressed T2 weighted sagittal images, a 1d T1 weighted axial image, and a 1e fat suppressed T1 weighted sagittal image following contrast administration Findings. Figure 2 2a T1 weighted sagittal, 3a T2 weighted sagittal, 4a T2 weighted sagittal with fat saturation, 5a T1 weighted axial at the L1 pedicle level and 6a post gadolinium T1 weighted sagittal with fat saturation reveal a moderate compression fracture of L1 with substantial preservation of normal marrow signal, particularly on the T1 weighted images. Retropulsion of bone, low intradiscal and possibly intraosseous signal suggestive of gas, a lack of substantial prevertebral soft tissue mass, a lack of abnormal signal material extending through the posterior vertebral body cortex, sharp or distinct margins of the retropulsed cortex, lack of involvement of the pedicles, and abnormal post contrast enhancement limited to the compressed portion of the centrum, all of which combine to depict a classic chronic benign fracture. Figure 3 T2 weighted fast spin echo sagittal. Signs of the benign nature of the fracture include preservation of normal T2 marrow signal compared to adjacent segments throughout most of the centrum, a visible fracture line or cleft arrow, and anterior wedging. Although the posterior cortex of the centrum is convex which in some circumstances is a worrisome sign, the cortical margin is sharp and intact and soft tissue does not extend dorsally into the epidural space. Figure 4 T2 weighted sagittal with application of fat saturation. Edematous type or fluid like signal and hyperemia are bright and more conspicuous on this sequence as it would be on STIR compared to the T2 weighted fast spin echo image displayed in 1b. This bright signal is very limited in this chronic fracture. Fluid is found in the fracture cleft arrow. Linear bright signal under the superior endplate arrowhead is most likely hyperemia in this case as the marrow has a normal appearance on the T1 weighted image 2a but intensely enhances as seen in 1e. The fracture has created a chronic biomechanical instability across this segment leading to signs of persistent stress on the segment from axial loading and physiologic motion. Figure 5 A T1 weighted axial image through the level of the pedicles. Benign signs include a lack of involvement of the pedicles and a lack of a paravertebral soft tissue mass. Figure 6 A T1 weighted post contrast sagittal with fat saturation. Enhancement of the compressed anterior aspect of the body arrowhead is due to a stress reaction and is also seen in association with the basivertebral vein. The majority of the remaining marrow does not enhance asterisks, though enhancement on conventional MR is not a good discriminator between benign and malignant fractures. No epidural enhancing lesion is seen. Low signal intradiscal and perhaps intraosseous gas is identified arrows. Diagnosis. Benign L1 compression fracture. Radsource MRI Web Clinic Pathologic Fractures. Clinical History 58 yo female with Stage 3A breast cancer presents to her family physician with back pain. Metacritic Game Reviews, Call of Duty Modern Warfare 2 for PC, Modern Warfare 2 continues the gripping and heartracing action as players face off against a new. Discussion. Deciding whether or not a fracture is benign or pathologic is a common decision confronting a musculoskeletal radiologist. The spine is a very common site for metastases and it has been reported that more than 1. RoyOrbisonMystryGirl500.jpg' alt='Reson 6 Only Demo' title='Reson 6 Only Demo' />Although any systemic malignancy may involve the spine, common solid organ primary tumors include breast, lung, and prostate, whereas common hematopoietic sources include myeloma and lymphoma. Although up to 7. A metastasis to the spine is the initial presentation in up to 2. Approximately 7. 0 of spine metastases occur in the thoracic spine. Involvement of the cervical spine or the thoracic spine above T5 is rare. Different primary tumors tend to spread to different parts of the spine for example breast and lung to the thoracic spine and prostate to the lumbar spine and sacrum. Since one third of vertebral fractures in oncology patients are benign and one quarter of fractures in patients with known osteopenia or osteoporosis are malignant, MRI is commonly performed to assist in the diagnosis 1,2,3,4,5. In acute non malignant fractures, the bone marrow becomes edematous or fills with fluid. This alters the relaxation time of the marrow leading to hypointensity on T1 weighted images and hyperintensity on T2 weighted or STIR short inversion time inversion recovery sequences. Usually a hyperemic response occurs leading to proliferation of fibroblastic and granulation tissue all of which evolve over time towards restoration of the primarily fat signal of normal marrow with healing. The time to complete healing is variable especially in the elderly with potentially impeded reparative capacity. Lessons Learned Template. Therefore a chronic osteoporotic fracture is more easily distinguished from an acute fracture by nearly completely normal marrow signal especially on T1 weighted and STIR images. Reson 6 Only Demographic Trump' title='Reson 6 Only Demographic Trump' />Hi, I am trying to access the HANA Analytic view thru the ABAP editor SE38 and i am getting error message insufficient privilege Not authorizedGiven below is. Updated world stock indexes. Get an overview of major world indexes, current values and stock market data. The RfMRI Network RFMRI. ORG a network for supporting restingstate fMRI related studiesChronic benign fractures especially in the elderly may continue to exhibit imaging signs of micromotion or stress for months to years by displaying some osseous edema or post contrast enhancement. Distinguishing an acute osteoporotic fracture from a pathologic fracture is more challenging. Many authors have contributed to our understanding of the expected MR findings in spinal fractures beginning with Yuh in 1. Baker in 1. 99. 0 7. Yuh reported that the vertebral body marrow is completely replaced in 8. There are a myriad of findings on routine MR sequences which are suggestive of a benign origin of a spine fracture 3,4,6,7,8,9,1. The above characteristics need to be considered together as no single factor is absolutely reliable in determining if a fracture is benign or malignant. The prevalence or importance of a single feature although reported in the literature can be disputed. For example one author reports that the presence of a fracture line is one of the most reliable signs of benignity 2. In younger patients usually a non traumatic pathologic fracture is associated with complete or near complete infiltration of the centrum. However in the elderly, weak bone predisposes to a fracture with only partial marrow replacement. Metastases tend to occur first in the posterolateral aspect of the vertebral body centrum and involve the pedicle late in the process 1. However osteoporotic fractures of the pedicles can occur. Fluid clefts are found in approximately 4. Acute benign fractures in the upper thoracic spine are relatively rare but slight presumed developmental concave deformities of the centra at T1, T2 or even T3 are not. Gadolinium contrast is usually not useful in differentiating a benign from a malignant fracture as both types of acute and subacute fractures enhance in unhealed areas. However contrast may be useful in distinguishing between a post traumatic disc herniation or hematoma from an epidural metastasis. Contrast may also be useful in better delineating an intraosseous mass if present. Call of Duty Modern Warfare 2 for PC Reviews. Infinity Ward has managed to outdo themselves with this sequel, a tremendous feat in its own right. If the games of 2. Modern Warfare 2 would be incredibly close to the apex, fighting viciously for the top spot and, for many people, getting there and continuing upward. This is what gaming is supposed to feel like.