Bone Pathology Database

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Lateral Xray Spine - Note the sclerosis of L4
The plain x ray shows a sclerotic L4 and L5. On the Magnetic resonance image a process infiltrating the tissues anterior and posterior to L4 and L5 vertebrae. The disc space has been spared.
One half of cases occur in the sacrococcygeal region and one third occur at the base of the skull. Other rare sites include transverse processes of vertebrae and the paranasal sinuses.
X ray Appearance
On plain x-ray, chordomas appear as a solitary mid-line lesion with bony destruction. There is often an accompanying soft tissue mass. Approximately half of the time focal calcifications are present. CT and MRI scans help demonstrate the soft tissue component, calcifications and epidural extension.
In some cases, sclerosis predominates, leading to an "ivory" vertebrae appearance. On MRI, on T1-weighted images 75% of lesions are isointense and 25% are hypointense to adjacent vertebrae. There is a tendency to skip the disc space and to directly invade adjacent vertebrae. On T2-weighted images the lesions have high intensity signal often with low-signal septa (70%).

Record 72