Case Author(s): Michael Roarke, MD and Jerold Wallis, MD , 11/2/95 . Rating: #D2, #Q4

Diagnosis: Radiation induced osteosarcoma of lumbar spine.

Brief history:

71-year old gentleman with back pain.


Views from delayed whole body bone scintigraphy.

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View second image(xr). Anteroposterior view of the lumbar spine.

View third image(ct). Axial CT image lumbar spine.

Full history/Diagnosis is available below

Diagnosis: Radiation induced osteosarcoma of lumbar spine.

Full history:

71-year old gentleman with a history of radiation treatment to the abdomen 11 years ago for a lymphoma. The patient recently developed back pain and radiographs demonstrated a large osteoblastic lesion of L3.


21.0 mCi Tc-99m MDP i.v.


The bone scintigraphy reveals a large focus of increased activity corresponding to the L3 vertebra and extending laterally into the paravertebral space on each side of the vertebra. No other suspicious lesions are identified in the skeleton. Computed tomography examination of the thoracolumbar spine dated 10-31-95 reveals an aggressive blastic expansile lesion of the L3 vertebra, consistent with osteosarcoma.


Approximately 2% of all osteosarcomas occur in the spine and approximately 4% of all osteosarcomas are radiation induced. Most osteosarcomas (80%) occur in the appendicular skeleton. This malignancy is associated with radionuclide treatment (e.g., following P-32 therapy) as well as external beam radiation (usual dose greater than 3,000 cGy in three weeks with a threshold of about 1,000 cGy). The latency is 4-42 years with an average of 11 years. Osteosarcomas and malignant fibrous histiocytomas are the two most common radiation-induced sarcomas. In a patient with treated Hodgkin¹s disease, the risk in five-year survivors for radiation-induced malignancy is approximately 0.9%. There is a bimodal age distribution for osteosarcoma with the first peak occurring at 10-25 years old and the second peak occurring greater than 60 years of age. The latter is usually associated with pre-existing conditions such as Paget¹s disease, radiation therapy, multiple hereditary exostoses, and fibrous dysplasia.

References: Resnick and Niwayama. Diagnosis of Bone and Joint Disorders, 3rd edition.

ACR Codes and Keywords:

References and General Discussion of Bone Scintigraphy (Anatomic field:Spine and Contents, Category:Neoplasm, Neoplastic-like condition)

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Case number: bs043

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