• Keyuan Chen, Chunyan Tian, Shaomin Yang, Songbo Han, Liang Jiang, Feng Wei, Huishu Yuan, Xiaoguang Liu, and Zhongjun Liu.
• Orthopaedic Department, Peking University Third Hospital, Beijing, China; Peking University Health Science Center, Beijing, China.
• World Neurosurg. 2021 Jan 1; 145: e209-e215.

BackgroundSpine osteoblastomas (OBs) are relatively rare. In contrast to osteoid osteoma, radiologic and clinical manifestations of OB can be varied and atypical. Typical radiographic features in spinal OB include peritumoral bone sclerosis, bone marrow edema, and soft tissue edema. Atypical radiographic features include lesions involving ≥3 segments, lesions with extensive (≥3 segments) bone sclerosis, excessive edema (≥3 segments) of soft tissue and bone marrow, no intralesional calcification, and location in the vertebral body only. The aim of this study was to identify typical and atypical features of OB.MethodsPretreatment computed tomography scans and magnetic resonance imaging were reviewed retrospectively. Percutaneous biopsies were performed to confirm pathology in atypical cases.ResultsA total of 50 images from patients with diagnosed OB were reviewed. Atypical radiographic features were found in 18 cases (36%). Pathologic diagnosis was confirmed as OB in 86.2% (25/29) cases after percutaneous computed tomography-guided biopsy.ConclusionsOur results show that >30% of spinal OB cases might have atypical radiographic features. In cases with atypical radiographic features, computed tomography-guided biopsies are recommended.Copyright © 2020 Elsevier Inc. All rights reserved.

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