Evaluation of Risk Factors for Vertebral Compression Fracture after Carbon-Ion Radiotherapy for Primary Spinal and Paraspinal Sarcoma

Figure 4

A 47-year-old man with a malignant peripheral nerve sheath tumor involving T1. (a) Axial T2-weighted MRI shows a huge, irregular, lobulated unilateral mass extending into the posterolateral component. (b) An axial myelo-CT scan shows the osteolytic mass. (c) Destruction of the vertebral body of T1 (20% collapse with kyphotic deformity) is also seen on sagittal T2-weighted MRI. (d) Histological examination shows the proliferation of oval to spindle cells arranged in a fascicular pattern with nuclear atypia and pleomorphism, confirming the diagnosis of malignant peripheral nerve sheath tumor (H&E, original magnification ×200). ((e) and (f)) Axial (e) and coronal CT (f) slices showing the dose distribution indicate the highly conformal nature of the C-ion RT. (g) Sagittal T2-weighted MRI at 5 months after C-ion RT (70.4 Gy (RBE)) demonstrates progression of the vertebral collapse and dislocation at the T1/2 level. (h) The patient underwent a posterior spinal fusion with instrumentation.

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