2008 Radiology Exam - CT/MRI Case 2

Signalment: 5 yr male neutered English Springer Spaniel
History: chronic progressive paraparesis and lumbar pain
Note: The candidates were given a maximum of 4 hardcopy films to interpret for each case. They were told to interpret based only on what was provided them. For this section, they would not be expected to ask for additional films.

See images below. Click to enlarge.

1. What are the available MRI pulse sequences and planes?

  • Transverse T1, transverse T2, Transverse and Sagittal T1+C

2. What are the imaging abnormalities?

  • Expansile, osteolytic, osteoproliferative mass in right L4 vertebra; extends into vertebral canal and paraspinal tissues, compresses the spinal cord, heterogeneously enhancing

2a. What is the artifact visible on the sagittal images?

  • motion

3. What are your prioritized differential diagnoses, based on the available information?

  • Right L4 vertebral mass, aggressive
  • Primary bone neoplasm (OSA, CSA, plasma cell tumor, FSA), metastatic neoplasm, osteomyelitis (less likely)

4. What imaging studies, tests or treatments would you recommend next and WHY?

  • Biopsy, thoracic rads, bone scan, debulk, radiation therapy