Lymphoma, Hodgkin (Spine)

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Diagnosis Definition

Hodgkin lymphoma/disease (HD) comprises 25% of all lymphomas; age of onset is bimodal, peaking first at 20 years and then at 55 years or older
5 – 32% of living patients with HD are diagnosed with bone marrow involvement (50% at autopsy); multiple osseous lesions (66%) are more common than single lesions
The dorsolumbar spine is the commonest site of skeletal HD
Patients usually present with pain localized to the site of involvement, or pathologic fracture

Imaging Findings

On radiographs and CT scanning, osteolytic lesions are commonest but lesions may be mixed or sclerotic; lytic lesions may appear sclerotic after treatment
Bone scintigraphy is abnormal in 98% of patients with skeletal HD
MRI is highly sensitive for showing marrow replacement, seen as low intensity on T1-weighted sequences and high intensity on T2; low intensity on T2 indicates fibrosis; STIR sequences show enhancement
An ivory vertebra represents diffuse sclerosis of a vertebral body; vertebra plana, a flattened vertebral body, is a less common finding but both may occur and are not limited to lymphoma

Pearls

Abnormalities can be seen on bone scintigraphy or MRI before radiographic changes are evident
CT best shows cortical and trabecular destruction, periosteal reaction, and sequestra
Differential considerations of an ivory vertebra in an adult include osteosarcoma, osteoblastic metastasis, myeloma, and Paget disease
MRI can show findings of HD and guide biopsy when sampling error results in a negative bone marrow biopsy

References

O’Neill J, Finlay K, Friedman L. Radiological manifestations of skeletal lymphoma. Curr Probl Diagn Radiol 2009; 38:228–236
Hwang S. Imaging of lymphoma of the musculoskeletal system. Radiol Clin North Am 2008; 46:379–396
Graham TS. The ivory vertebra sign. Radiology 2005; 235:614–615

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