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. 2022 Oct;66(7):913-919.
doi: 10.1111/1754-9485.13365. Epub 2021 Dec 1.

Differentiation between spinal subchondral bone metastasis with focal pathologic endplate fracture and oedematous Schmorl's node

Eunsun Oh  1 , Hyun-Joo Kim  1 , Jong Won Kwon  2 , Young Cheol Yoon  3 , Hyun Su Kim  3
Affiliations

Differentiation between spinal subchondral bone metastasis with focal pathologic endplate fracture and oedematous Schmorl's node

Eunsun Oh et al. J Med Imaging Radiat Oncol. 2022 Oct.

Abstract

Introduction: We aimed to identify imaging-based findings that can differentiate between spinal subchondral bone metastasis with focal pathologic endplate fracture and oedematous Schmorl's nodes that have been histopathologically confirmed.

Methods: Between March 2010 and April 2016, 11 patients who had undergone spinal magnetic resonance (MR) imaging or computed tomography (CT) with final radiologic reports that included 'subchondral bone metastasis with focal pathologic endplate fracture' or 'edematous Schmorl's node' and had also undergone percutaneous imaging-guided spinal biopsies were included. Two radiologists retrospectively evaluated the following imaging features in consensus: size, location, presence of sclerotic margin, presence of intralesional or perilesional enhancement and opposite endplate enhancement of the involved disc, presence of disc height loss and presence of metabolic uptake at a corresponding lesion on nuclear medicine imaging.

Results: A total of 11 patients, including six patients with spinal subchondral bone metastasis with focal pathologic endplate fracture and five patients with oedematous Schmorl's nodes, were included in this study (median age, 58 years; range, 50-63 years; six men). Sclerotic margin (P = 0.002) and enhancement on the opposite endplate of the involved disc (P = 0.047) were significantly different between oedematous Schmorl's node and subchondral bone metastasis with focal pathologic endplate fracture.

Conclusion: Sclerotic margin and enhancement on the opposite endplate of the involved disc suggest oedematous Schmorl's node rather than subchondral bone metastasis with focal pathologic endplate fracture. Decreased disc height is likely to be an oedematous Schmorl's node rather than subchondral bone metastasis with focal pathologic endplate fracture.

Keywords: Schmorl’s node; Spine imaging; bone neoplasm; magnetic resonance imaging; musculoskeletal imaging.

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