Intramedullary Spinal Cord Metastases: MRI and Relevant Clinical Features from a 13-Year Institutional Case Series

Abstract

BACKGROUND AND PURPOSE:Because intramedullary spinal cord metastasis is often a difficult diagnosis to make, our purpose was to perform a systematic review of the MR imaging and relevant baseline clinical features of intramedullary spinal cord metastases in a large series.

Intramedullary Spinal Cord Metastases: Visibility on PET and Correlation with MRI Features

“…Missing ISCMs can delay diagnosis, and identifying and treating ISCM(s) early improves outcomes. 15,16 The fact that ISCMs can be asymptomatic or present with minimal neurologic symptoms [7][8][9]12,14,15 also underscores the importance of detecting the lesions on early imaging, even when other evidence of metastatic disease is present, as there was for most patients in the current study. Similarly, the results of our study should encourage those who do not interpret PET primarily but correlate with it when interpreting MR imaging to actually review the PET images, not just the interpretation.…”

“…Several MR imaging lesion characteristics previously analyzed by 2 radiologists (F.E.D. and J.B.R., a neuroradiology fellow with an American Board of Radiology certification) 13,14 were noted:…”

Intramedullary Spinal Cord Metastases: Prognostic Value of MRI and Clinical Features from a 13-Year Institutional Case Series

“…1 Five (9%) of these 58 patients were again excluded due to a lack of available pretreatment MR imaging examinations. Additional details of the study population were as reported in the prior studies 1,2 ; specifically, 4 (8%) of the remaining 53 patients "were excluded because alternative diagnoses were being considered clinically and ISCM was never formally diagnosed." 1 2 The MR imaging examinations were predominantly from our institution, but some were from outside facilities.…”

“…As detailed in a prior study, 2 the pathologic, surgical, clinical, and radiologic data bases at our single institution were queried to identify a group of consecutive patients with ISCMs (n ϭ 58, 1999 -2011). Exclusion criteria were patients in whom ISCM was never formally clinically diagnosed, patients in whom alternative diagnoses were suspected clinically, and patients without available pretreatment digital MR images.…”

“…MR imaging findings specific to these secondary compared with primary tumors of the spinal cord have been described. 1 Moreover, multiple MR imaging characteristics have been characterized in detail 2 and correlated with findings on physiologic imaging with PET. 3 However, the prognostic value of MR imaging and clinical findings has not been assessed, to our knowledge.…”