Use of magnetic resonance imaging in the evaluation of metastatic spinal disease

Spinal metastases are present in up to 10% of all cancer patients at some time during the course of their disease. Pain is the most common presenting symptom, and neurological function is usually normal at this early stage. The clinical challenge is to detect and treat the spinal disease before the onset of neurological compromise. Myelography has been the standard test for identification of epidural metastases, but the invasive nature of myelography carries inherent risk and produces patient discomfort. Magnetic resonance imaging (MRI) has been useful in the evaluation of other spinal diseases, is noninvasive, and is tolerated well by patients. We evaluated and compared MRI (64 studies in 58 patients) to conventional studies (myelography, computed tomography, bone scanning, plain films) and determined its accuracy in diagnosis and efficacy in clinical decision making. MRI proved superior in detecting bone and epidural involvement by tumor and was valuable in clinical decision making. In addition, MRI provided better visualization of paravertebral soft tissue involvement by tumor. MRI is recommended as the initial study in patients with suspected metastatic spinal disease.