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Ivory Vertebra sign refers to uniform, diffuse increased radiodensity of a vertebral body seen on radiographs or CT, without alteration in vertebral height or contour.
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Mnemonic: PHOIL
| Cause | Details |
|---|---|
| P - ‣ | Early phase may cause trabecular coarsening and sclerosis. Commonly asymmetric; may involve posterior elements. |
| H - ‣ | Classically causes ivory vertebra (especially in thoracic spine). Associated soft tissue mass may be seen. |
| O - Osteoblastic metastases | From prostate, breast, carcinoid, or bladder cancers. Often multiple vertebrae involved. |
| I - Infection (chronic osteomyelitis or TB) | Can cause sclerosis but often with endplate irregularities and disc involvement. |
| L - Lymphoma (non-Hodgkin) | Similar to Hodgkin; ivory appearance possible but less specific. |
| Modality | Imaging features |
|---|---|
| XR/CT | • Diffusely opaque vertebral body. |
| • Normal disc spaces, endplates preserved. | |
| • No paravertebral soft tissue mass (unless due to lymphoma or infection). | |
| MR | • T1: hypointense |
| • T2: variable (may help identify marrow replacement or associated mass) |
Asymptomatic 67-year-old patient with Paget’s disease. AP (A) and profile (B) X-rays showing increased density of the L4 vertebral body (arrows).
Braun RA, Milito CF, Goldman SM, Fernandes Ede Á. Ivory vertebra: imaging findings in different diagnoses. Radiol Bras. 2016;49(2):117-121. doi:10.1590/0100-3984.2014.0103
62-year-old patient with lymphoma and low back pain. AP (A) and profile (B) X-rays showing a diffuse increase in bone density, with erosion on the left side of the L4 vertebral body (arrow).
Braun RA, Milito CF, Goldman SM, Fernandes Ede Á. Ivory vertebra: imaging findings in different diagnoses. Radiol Bras. 2016;49(2):117-121. doi:10.1590/0100-3984.2014.0103
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