Primary and Secondary Vertebral Tumors: A Diagnostic Algorithm

In this chapter, we describe the differential diagnosis of focal bone marrow lesions due to primary and secondary spinal bone tumors. Spine metastases are the most common malignant vertebral lesions, while primary spinal bone tumors represent quite rare entities in vertebral pathology, with an incidence ranging from 2.5 to 4 per 100,000 of the population, with hematologic disorders being the most frequent entity. Radiologists play an important role in the diagnosis and follow-up of vertebral tumors, with CT and MRI being the essential techniques to reach a correct diagnosis. There is a complementary role for nuclear medicine imaging, such as PET/CT or bone scan, which can be helpful for differential diagnosis, staging, and follow-up, especially in hematologic disorders. Image-guided biopsy can be required in some cases for final diagnosis and directing treatment.