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. 2016 Mar-Apr;49(2):117-21.
doi: 10.1590/0100-3984.2014.0103.

Ivory vertebra: imaging findings in different diagnoses

Richard Andreas Braun  1 , Carlos Felipe do Rego Barros Milito  2 , Suzan Menasce Goldman  3 , Eloy de Ávila Fernandes  4
Affiliations

Ivory vertebra: imaging findings in different diagnoses

Richard Andreas Braun et al. Radiol Bras. 2016 Mar-Apr.

Abstract
in English, Portuguese

Low back pain is often managed at all levels of healthcare. In general, diagnostic investigation begins with radiography of the lumbar spine. In addition to the most common findings, radiologists can identify increased density of a vertebral body, referred to as ivory vertebra. The objective of this study was to describe the main diseases that can present with this radiologic sign, such as Hodgkin lymphoma, Paget's disease, metastatic prostate cancer, breast cancer, and osteomyelitis. It is extremely important that radiologists be aware of this finding in order to inform the requesting physician of the possible etiologies, given that it can be the initial radiologic presentation for these diseases.

Pacientes com dor lombar são frequentemente atendidos em todos os níveis de saúde. O início da investigação diagnóstica, de modo geral, se dá com a realização das radiografias da coluna lombar. Além dos achados mais frequentes, os profissionais podem encontrar uma vértebra de densidade muito aumentada em comparação com as demais, chamada de vértebra em marfim. O objetivo deste trabalho é descrever as principais doenças que podem apresentar, entre suas características radiológicas, este tipo de vértebra, como linfoma de Hodgkin, doença de Paget, metástases de neoplasias prostáticas e de mama, além da osteomielite. Por ser, em alguns casos, a apresentação radiológica inicial dessas doenças, é de suma importância que o radiologista tenha conhecimento deste achado e oriente o profissional solicitante quanto às suas possíveis causas.

Keywords: Lymphoma; Neoplasm metastasis; Osteitis deformans; Osteomyelitis; Spine.

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Figures

Figure 1
Figure 1
Computed tomography (cross section) of the backbone, L1 level, showing the vertebral elements, including the body (1), lamina (2), pedicles (3), transverse processes (4), and spinous process (5). The usual vertebral density of the cortical bone (6) and medullary bone (7) can also be seen.
Figure 2
Figure 2
Asymptomatic 67-year-old patient. Anteroposterior (A) and profile (B) X-rays showing increased density of the L4 vertebral body (arrows).
Figure 3
Figure 3
62-year-old patient with lymphoma and low back pain. Anteroposterior (A) and profile (B) X-rays showing a diffuse increase in bone density, with erosion on the left side of the L4 vertebral body (arrow).
Figure 4
Figure 4
62-year-old patient with prostate cancer. computed tomography scans in the axial, sagittal, and coronal planes (A, B, and C, respectively), showing osteoblastic lesions with an increase in the density of the vertebral body and of the posterior vertebral elements (in B). Lesions are spread throughout the bone framework (arrows).
Figure 5
Figure 5
Computed tomography with sagittal reconstructions (A,B) and T2- weighted magnetic resonance imaging, in the sagittal plane, of the thoracolumbar transition (C). There is a density increase of the vertebral body (arrowheads) accompanied by bone erosion (arrows) at the margins of the intervertebral discs and collection (curved arrow) adjacent and anterior to the vertebral bodies (in C).
See this image and copyright information in PMC

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