“Wrap-Around Sign” in Non-Hodgkin Lymphoma of the Spine: A Common yet Overlooked Imaging Feature?

Tomas Marek, Christopher H. Hunt, B. Matthew Howe, Robert J. Spinner

Research output: Contribution to journalArticlepeer-review


Background: Anecdotal cases of the so-called “wrap-around” appearance in non-Hodgkin lymphoma (NHL) of the spine exist in the medical literature. In this paper, we looked at the prevalence of this imaging feature in our institutional cases. Materials and Methods: We screened our institutional database for biopsy-proven NHL. Our inclusion criteria were the histologically confirmed diagnosis of NHL involving any vertebra, available magnetic resonance imaging of the affected site, and a positive wrap-around sign. Exclusion criteria included lymphoma cases without the wrap-around sign and/or histology other than NHL. We subdivided the cases into 3 groups: 1) lymphoma wrapped around the vertebral body; 2) the posterior elements alone; or 3) both the vertebral body and posterior elements. Results: Our search identified 147 cases of NHL in which a confirmatory biopsy at the primary tumor site was available. Of those, 23 cases fulfilled the inclusion criteria (16 men and 7 women with average age at diagnosis of 63.3 years), yielding prevalence of 15.6% in our series. Most commonly the lymphoma involved the vertebral body with or without some involvement of the posterior vertebral elements (n = 20, 86.9%), followed by posterior vertebral elements (n = 2, 8.7%). One remaining case (4.4%) had lymphoma involving the anterior vertebral body and posterior elements. Conclusions: Findings of our pilot study indicated that the wrap-around sign in cases of NHL could be helpful diagnostically. This sign may be frequently under-recognized, leading to potential for a diagnostic dilemma on imaging. Larger studies are necessary to obtain more precise information about the prevalence of the wrap-around sign.

Original languageEnglish (US)
Pages (from-to)e457-e465
JournalWorld neurosurgery
StatePublished - Jul 2021


  • Lymphoma
  • Non-Hodgkin lymphoma
  • Spine
  • Wrap-around sign

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology


Dive into the research topics of '“Wrap-Around Sign” in Non-Hodgkin Lymphoma of the Spine: A Common yet Overlooked Imaging Feature?'. Together they form a unique fingerprint.

Cite this