Delayed vertebral body collapse after stereotactic radiosurgery and radiofrequency ablation: Case report with histopathologic-MRI correlation.
Stereotactic radiosurgery and percutaneous radiofrequency ablation are emerging therapies for pain palliation and local control of spinal metastases. However, the post-treatment imaging findings are not well characterized and the risk of long-term complications is unknown. We present the case of a 46-year-old woman with delayed vertebral body collapse after stereotactic radiosurgery and radiofrequency ablation of a painful lumbar metastasis. Histopathologic-MRI correlation confirmed osteonecrosis as the underlying etiology and demonstrated that treatment-induced vascular fibrosis and tumor progression can have identical imaging appearances.
Mallinckrodt Institute of Radiology, Siteman Cancer Center, Washington University School of Medicine, Saint Louis, MO, USA wallacea@mir.wustl.edu.
Adam N
AN
Wallace
Washington University School of Medicine, Saint Louis, MO, USA.
Ross
R
Vyhmeister
Department of Pathology and Immunology, Division of Anatomic Pathology, Washington University School of Medicine, Saint Louis, MO, USA.
Andy C
AC
Hsi
Department of Radiation Oncology, Siteman Cancer Center, Washington University School of Medicine, Saint Louis, MO, USA.
Clifford G
CG
Robinson
Washington University School of Medicine, Saint Louis, MO, USA.
Randy O
RO
Chang
Mallinckrodt Institute of Radiology, Siteman Cancer Center, Washington University School of Medicine, Saint Louis, MO, USA.
Jack W
JW
Jennings
D017115:Catheter Ablation; D017809:Fatal Outcome; D005260:Female; D019788:Fluorodeoxyglucose F18; D050815:Fractures, Compression / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D006801:Humans; D061705:Image-Guided Biopsy; D007890:Leiomyosarcoma / Q000000981:diagnostic imaging / Q000556:secondary / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D010147:Pain Measurement; D000072078:Positron Emission Tomography Computed Tomography; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D019275:Radiopharmaceuticals; D016634:Radiosurgery; D016103:Spinal Fractures / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D013125:Spinal Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary / Q000601:surgery*
D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18
Metastatic spine disease; radiofrequency ablation; spinal stereotactic radiosurgery; vertebral augmentation; vertebral compression fracture