Imaging appearance of giant cell tumour of the spine above the sacrum

Abstract

Giant cell tumour (GCT) of the spine is rarely encountered in daily clinical practice. Most of the tumours occur at the sacrum instead of at the spine above the sacrum, which has been reported to account for 1.3-9.3% of all spine GCTs. This article is a review of our radiological experience of the diagnosis of spine GCT above the sacrum based on 34 patients at a single institution. The purpose of this pictorial review is to highlight the imaging findings of GCT and to provide clues that may distinguish it from other, more common neoplasms.

Figure 1.

(a–d) A 36-year-old female with giant cell tumour of C6–T1. (a) Sagittal reconstruction of CT image reveals that the lesion involves three vertebral segments and complete vertebra plana of C7 with an anterior soft-tissue mass (asterisk). (b) Sagittal T₁ weighted MRI shows heterogeneous isosignal large mass in the anterior soft tissue and intraspinal canal that compresses the dura and spinal cord. (c) Sagittal T₂ weighted MRI shows low signal intensity of the solid component of the tumour (arrows) and cystic areas (asterisk). The intervertebral disc appears to be intact. (d) Sagittal T₂ weighted MRI in the lateral slice showing cystic areas (black arrows) and zonal low signal area (white arrow) caused by haemosiderin deposition.

Figure 2.

(a–d) A 29-year-old female with giant cell tumour of L1. (a) Anteroposterior radiograph shows expansile osteolytic destruction of L1. The cortex in the right edge of the vertebral body (white arrows) and the oval structure of the right pedicle disappear (asterisk). (b) Sagittal reconstructed CT image shows the lesion displaying isomuscle density with long bony septa (white arrows). (c) Axial CT image shows that the lesion arises from the vertebral body with eccentric distribution and extends to the right pedicle and articular facet. Long bony septa from the border of the tumour extending to the inside of the tumour are seen opposite to the eccentric side (arrows). The cortex disappears in some lytic areas. (d) Axial T₂ weighted MRI shows that the tumour extends to the paravertebral soft tissue and spinal canal, causing spinal cord and nerve root compression. Curvilinear low signal areas are also seen (arrows).

Figure 3.

(a–d) A 43-year-old female with giant cell tumour of L1. (a) Anteroposterior radiograph of the lumbar spine shows an expansile osteolytic lesion with large soft tissue mass (white arrows). The oval structure of the left pedicle disappears (asterisk). (b) Coronal reconstructed CT image showing the sclerotic rim appears at the border of the tumour opposite to the eccentric side (white arrows). (c) Axial CT image shows the short bony septa (white arrow) and sclerotic rim (grey arrows) opposite to the eccentric side. (d) Axial T₂ weighted MRI displays a low signal intensity lesion that extends to the paravertebral soft tissue and spinal canal, causing spinal cord and nerve root compression.

Figure 4.

(a, b) A 25-year-old female with giant cell tumour of L2. (a) Axial T₂ and (b) sagittal T₂ weighted MR images show the lesion displaying heterogeneous signal intensity with multiple cystic areas and fluid–fluid levels (arrows). The lesion extends to the paravertebral soft tissue and spinal canal, causing spinal cord and nerve root compression.

Figure 5.

(a, b): A 32-year-old female with giant cell tumour of L5. (a) Axial CT image shows a geographical lesion with isomuscle density. Bony septa (black arrows) are seen at the border of the tumour opposite to the eccentric side. Areas of disappearance of the cortex and associated soft-tissue mass are seen (white arrows). (b) Sagittal T₁ weighted MRI displaying a band of low signal intensity (white arrow) around the margin of the tumour and linear low signal intensity (black arrow) within the tumour.

Figure 6.

(a, b) A 44-year-old female with giant cell tumour of T7. (a) Anteroposterior radiograph of the thoracic spine shows destruction of the posterior elements, the left pedicle disappears. A large soft-tissue mass (white arrows) is seen in the paravertebral line. (b) Axial CT image shows the tumour arising from the posterior elements with extension to the vertebral body. Bony septum (white arrow) and thin sclerotic border (black arrow) are also seen.

Figure 7.

(a, b) A 25-year-old female with giant cell tumour of L5. (a) Sagittal T₂ weighted MRI shows an expansile low signal intensity lesion in L5. (b) Contrast-enhanced coronal T₁ weighted MRI shows marked heterogeneous enhancement of the tumour. The adjacent intervertebral discs are partly involved (arrow).