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

Diehn, Felix E.; Rykken, Jeffrey; Wald, John T.; Wood, Chris; Eckel, L. J.; Hunt, Christopher H.; Schwartz, Kara M.; Lingineni, Ravi K.; Carter, R. E.; Kaufmann, Timothy J.

doi:10.3174/ajnr.a4160

“…The interval from primary cancer to ISCM spanned up to 10 years, reminding clinicians of the possibility of ISCM in cancer populations presented with typical neurological deficits and MRI findings, even after a long latency. The thoracic segment appeared to be the most common involved (77.05%), similar to the reports by Diehn et al,9 Rykken et al10 and Payer et al11 Rades and Schiff13 while Findlay et al19 found that the cervical segment was the most common site. Unsurprisingly, lung cancer was the main offender of ISCM, especially the subset of SCLC tending to have ISCM, followed by breast cancer, the same as previous reports 1,2,5,9,10.…”

Section: Discussionsupporting

confidence: 85%

“…In terms of factors influencing therapeutic activity, ISCM originated from lung/breast carcinomas having a poorer survival than other pathological types. Besides, multiple ISCMs is also a worse prognostic indicator 9. Multiple spinal cord levels involvement and no treatment were unveiled to be poor prognostic factors of OS.…”

Section: Discussionmentioning

confidence: 98%

“…However, due to the relative low occurrence of ISCM and general setting of end-stage of cancer, no prospective studies have been conducted to date 13. As for the retrospective study, the largest research included 49 patients 9,10. Sung et al1 performed a 20-year retrospective study in the Royal Hobart Hospital of eight ISCM patients and reviewed 291 ISCM cases published in the literature since 1960.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

<p>Intramedullary spinal cord metastasis in malignancies: an institutional analysis and review</p>

Lv

¹

,

Liu

²

,

Quan

³

et al. 2019

OTT

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Background: Intramedullary spinal cord metastases (ISCM) in malignancies is a devastating issue with limited research. This study aims to identify the clinical features, management, prognostic factors, and outcomes of this special entity. Methods: A retrospective review of 61 patients of ISCM diagnosed and treated in our institute from June 2010 to March 2018 was conducted (lost to follow-up: 3). Data were retrieved according to the items including age, gender, primary tumor, interval to the ISCM occurrence, ISCM segments, and other synchronous metastases. The interventions, response, prognostic factors, and outcomes of ISCM were systematically analyzed. Results: Lung cancer (67.21%) was the commonest ISCM source, followed by breast cancer (14.75%). In total, 9.84% of patients presented with ISCM initially. The mean span from the primaries to ISCM was 18.77 months (range=0–10 years). The thoracic segment was most commonly involved (77.05%), followed by cervical (39.34%), lumbar level (34.43%), and conus medullaris (6.56%). The management of ISCM was challenging, since 55.74% of individuals had a poor physical condition (PS=3–4) and 72.41% had widespread dissemination synchronously (≥2 organs). Radiotherapy (RT) attained an objective response rate (ORR) of 61.90% or 62.50% and a local control rate (LCR) of 90.48% or 87.50% for symptoms used alone or with other strategies, respectively. ISCM bears a dismal prognosis, with a median overall survival (OS) of 4 months. Patients with only one segment involved had an apparently better prognosis than those with 2–4 involved segments (median OS=7.0 vs 3.0 months) ( P <0.01). The OS of patients treated was remarkably superior to those without any intervention (median OS=5.0 vs 2.0 months) ( P <0.01). Conclusion: ISCM is a distinct entity needing more attention for high cancer incidence, prolonged survival, and lack of research. RT is the mainstay with satisfactory effect. Multiple spinal cord segments involvement and no treatment are poor prognostic factors of OS.

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“…The cyst and nodule pattern often seen with cerebellar hemangioblastomas may be absent in spinal lesions. Spinal cord metastatic lesions demonstrate variable imaging findings; however, the majority enhance homogeneously with surrounding edema (58).…”

Section: Differential Diagnosismentioning

confidence: 99%

Spinal Hematomas: What a Radiologist Needs to Know

Pierce

¹

,

Donahue

²

,

Nacey

³

et al. 2018

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Spinal hematomas are a frequent indication for radiologic evaluation and can be a diagnostic dilemma for many radiologists and surgeons. There are four types of spinal hematomas: epidural, subdural, subarachnoid, and intramedullary (spinal cord) hematomas. Because they differ by their location in relationship to the meningeal membranes and spinal cord, unique radiologic appearances can be recognized to distinguish these types of spinal hemorrhage. Anatomic knowledge of the spinal compartments is essential to the radiologist for confident imaging diagnosis of spinal hematomas and to specify correct locations. MRI is the modality of choice to diagnose the location of the hematoma, characterize important features such as age of the hemorrhage, and detect associated injury or disease. Each type of spinal hematoma has imaging patterns and characteristics that distinguish it from the others, as these specific spinal compartments displace and affect the adjacent anatomic structures. Early detection and accurate localization of spinal hematomas is critical for the surgeon to address the proper treatment and surgical decompression, when necessary, as neurologic deficits may otherwise become permanent. Online supplemental material is available for this article. RSNA, 2018.

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“…Das bei zerebellären Hämangioblastomen häufig imponierende zystische oder noduläre Muster kann bei spinalen Tumoren fehlen. Metastasen im Bereich des Rückenmarks sind durch unterschiedliche Bildgebungsmerkmale gekennzeichnet, die meisten zeigen jedoch eine homogene Kontrastmittelanreicherung und ein perifokales Ödem [58].…”

Section: Radiologische Befundeunclassified

Spinale Hämatome: Was der Radiologe wissen muss

Pierce¹,

Donahue²,

Nacey³

et al. 2019

Neuroradiol Scan

0

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Spinal hematomas are a frequent indication for radiologic evaluation and can be a diagnostic dilemma for many radiologists and surgeons. There are four types of spinal hematomas: epidural, subdural, subarachnoid, and intramedullary (spinal cord) hematomas. Because they differ by their location in relationship to the meningeal membranes and spinal cord, unique radiologic appearances can be recognized to distinguish these types of spinal hemorrhage. Anatomic knowledge of the spinal compartments is essential to the radiologist for confident imaging diagnosis of spinal hematomas and to specify correct locations. MRI is the modality of choice to diagnose the location of the hematoma, characterize important features such as age of the hemorrhage, and detect associated injury or disease. Each type of spinal hematoma has imaging patterns and characteristics that distinguish it from the others, as these specific spinal compartments displace and affect the adjacent anatomic structures. Early detection and accurate localization of spinal hematomas is critical for the surgeon to address the proper treatment and surgical decompression, when necessary, as neurologic deficits may otherwise become permanent.

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

Cited by 18 publications

References 7 publications

<p>Intramedullary spinal cord metastasis in malignancies: an institutional analysis and review</p>

<p>Intramedullary spinal cord metastasis in malignancies: an institutional analysis and review</p>

Spinal Hematomas: What a Radiologist Needs to Know

Spinale Hämatome: Was der Radiologe wissen muss

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