Picture Frame Sign

‘One picture is worth more than a thousand words’ says the Chinese proverb ¹ . Picture frames can also be very expressive, as is the case with the term used for one type of Pagetoid change seen in a vertebral body. Georg Schmorl ² , ³ (1861–1932), who wrote extensively on disorders of the spine, gave radiologists this picture-frame analogy in two of his articles that dealt with Pagetoid changes in the spine. He correlated the gross pathologic and roentgenographic changes of Paget’s disease in the spinal column. Schmorl found that in Paget’s disease the trabeculae at the edges of the vertebral bodies seemed compacted and were more dense than those in the midbody. To him, these compact dense trabeculae surrounding the midbody suggested the likeness of a framework or picture frame (rahmenartig). This appearance of a coarsened thickened framework, outlining a vertebral body, is a roentgen classic that is diagnostic of Paget’s disease (Figures 1 and 2). No other words are necessary when one sees this ‘picture frame’. Figure 1 Photograph of specimen from Schmorl’s work clearly showing the framework phenomenon in the second lumbar vertebra (L2). Reprinted from Schmorl<xref ref-type="bibr" rid="ref63_3"> ³ </xref>. Uber Ostitis deformans Paget <italic>Vtrchows Arch. Pathol. Anat Physiol. Klin. Med.,</italic> 1932.283,694–751, with permission of Springer-Verlag https://s3-euw1-ap-pe-df-pch-content-public-p.s3.eu-west-1.amazonaws.com/9781003076568/34c29fd5-5662-4e8f-b58c-badd7fa5d724/content/fig63_1_B.jpg"/> Figure 2 Lateral spine radiograph with typical picture-frame appearance due to Paget’s disease. Case courtesy of Dr C. Resnik, University of Maryland https://s3-euw1-ap-pe-df-pch-content-public-p.s3.eu-west-1.amazonaws.com/9781003076568/34c29fd5-5662-4e8f-b58c-badd7fa5d724/content/fig63_2_B.jpg"/>