Abnormal Thoracic Spine MRI but Normal Nuclear Bone Scan??

[AliChapman]

I am a 33 year old woman and have been having stomach pain for the past 6 months. I have been to the ER twice.  My last visit was in June but this time my pain was also in my right side mid to lower back area.  The pain radiates into my ribs and runs up the side of my spine.  The ER doctor gave me pain meds and told me to have a MRI of the Thoracic Spine without contrast.  I did this and my doctor informed me that the results were  "ABNORMAL".  The reports states the following, "there is nearly a 1 cm long focus of abnormal signal within the bone marrow of the T3 vertebral body posterolaterally on the right just below the superior endplate.  The signal characteristics of the signal focus are nonspecific, although in a young patient this age, an atypical hemangioma would be favored rather than a metastasis".  The radiologist recommended me to do a nuclear bone scan, which I did.  I was just informed by my Dr. that the bone scan came back "NORMAL".  There were no abnormal findings and "no evidence of increased activity within the T3 verterbral body".  I am so confused!  How can I have an MRI that indicates something abnormal (specifically in the T3 bone marrow) and a bone scan that finds everything to be ok?   I have been worried sick about the abnormal MRI.  Any explanation regarding this would be greatly appreciated.

[PaulMD]

Hi.  I believe that the lesion seen on the MRI is still there.  Hemangiomas are not that common but not rare altogether.  This would only become a problem if it produces compression of nerves or other structures.  I believe that surveillance with follow up MRI's may be warranted.  However, this is just my opinion and it is best to discuss this more with your doctor.  Regards.

[AliChapman]

So the abnormality that was seen in the MRI is still present? It just doesn't show up on the bone scan?  Do you think I should have the MRI repeated in a few months?  Is a hemangioma in the bone marrow of a vertebrae common?  Is it something I should be worried about? I don't have pain in this area (T3), I have pain in my mid-lower right side in my ribs.  Thank you for your help!

[PaulMD]

Hi there.  The MRI and bone scan works by two very different mechanisms.  An MRI is an imaging study where it will only detect abnormal topographical or physical structures of the areas scanned.  A bone scan can detect areas in the bone of increased bone turn over or increased remodelling, much like what is seen in patients with metastatic cancers to the bone/spine. The bone scan depends on the functional aspect of the bones scanned (in contrast to MRI which depends just on the physical appearance).   In your case, I'm not surprised at all that the bone scan is normal, since the MRI is considering a hemangioma (abnormal blood vessel formation) which does not cause bone remodelling, bone turn over, or any alteration in the bone's functions.