Related Experiment Video
Updated: Oct 4, 2025
Establishment of Orthotopic Patient-derived Xenograft Models for Brain Tumors using a Stereotaxic Device
Published on: May 2, 2025
Indolent enhancing spinal lesions mimicking spinal metastasis in pediatric patients with malignant primary brain
Hsin-Wei Wu1,2, Shih-Chieh Lin2,3, Ching-Lan Wu1,2
1Department of Radiology, Taipei Veterans General Hospital, 201 Sec. 2, Shih-Pai Rd., Taipei, 11217, Taiwan.
Abstract:
Spinal metastasis from malignant primary brain tumors (MPBTs) in pediatric patients is rare and often appears as enhancing lesions on MRI. However, some indolent enhancing spinal lesions (IESLs) resulting from previous treatment mimic metastasis on MRI, leading to unnecessary investigation and treatment. In 2005-2020, we retrospectively enrolled 12 pediatric/young patients with clinical impression of spinal metastasis and pathological diagnosis of their spinal lesions. Three patients had MPBT with IESL, and 9 patients had malignant tumors with metastases. The histopathologic diagnosis of IESL was unremarkable marrow change. We evaluated their MRI, CT, and bone scan findings. The following imaging findings of IESL vs. spinal metastasis were noted: (1) IESLs appeared round/ovoid (3/3, 100%), whereas spinal metastasis appeared irregular (9/9, 100%) (P = 0.005); (2) target-shaped enhancement was noted in (3/3, 100%) vs. (0/9, 0%) of cases, respectively (P = 0.005); (3) pathologic fracture of the vertebral body was noted in (1/3, 33.3%) vs. (9/9, 100%) of cases, respectively (P = 0.045); (4) expansile vertebral shape was noted in (0/3, 0%) vs. (9/9, 100%) of cases, respectively (P = 0.005); (5) obliteration of the basivertebral vein was noted in (0/3, 0%) vs. (9/9, 100%) of cases, respectively (P = 0.005); and (6) osteoblastic change on CT was noted in (3/3, 100%) vs. (2/9, 22.2%) of cases, respectively (P = 0.034). IESL in pediatric patients with MPBT can be differentiated from metastasis based on their imaging characteristics. We suggest close follow-up rather than aggressive investigation and treatment for IESL.
Insights
Spinal metastasis from pediatric primary brain tumors is rare. Indolent enhancing spinal lesions (IESLs) can mimic metastasis on MRI, but distinct imaging features allow differentiation, suggesting follow-up over aggressive treatment.
Area of Science:
- Pediatric Radiology
- Oncology Imaging
- Spinal Imaging
Background:
- Spinal metastasis from malignant primary brain tumors (MPBTs) in pediatric patients is uncommon.
- Indolent enhancing spinal lesions (IESLs) from prior treatment can be misdiagnosed as metastasis on MRI.
- Misdiagnosis can lead to unnecessary investigations and treatments in pediatric patients.
Purpose of the Study:
- To differentiate IESLs from spinal metastasis in pediatric patients with MPBTs using imaging characteristics.
- To evaluate the utility of MRI, CT, and bone scan findings in distinguishing these conditions.
Main Methods:
- Retrospective analysis of 12 pediatric patients diagnosed with spinal lesions between 2005-2020.
- Patients included those with MPBT and IESL (n=3) and malignant tumors with metastases (n=9).
- Evaluation of imaging findings including lesion shape, enhancement pattern, vertebral body changes, and venous involvement.
Main Results:
- IESLs were round/ovoid and showed target-shaped enhancement, unlike irregular metastases.
- Metastases frequently presented with vertebral body pathologic fracture, expansile shape, and basivertebral vein obliteration.
- Osteoblastic changes on CT were more common in IESLs (100%) compared to metastases (22.2%).
Conclusions:
- Distinct imaging characteristics of IESLs in pediatric patients with MPBTs can differentiate them from spinal metastases.
- These findings support close follow-up for suspected IESLs instead of aggressive diagnostic and therapeutic interventions.
- Accurate differentiation is crucial to avoid overtreatment and manage pediatric patients effectively.
