Diagnosis of vertebral metastasis, epidural metastasis, and malignant spinal cord compression: are T-1-weighted sagittal images sufficient?

The objective of this study was to determine whether T-1-weighted sagittal images alone are adequate in the diagnosis of vertebral metastasis, epidura l metastasis, and malignant spinal cord compression. Ninety-four complete m agnetic resonance (MR) studies of the spinal column (a complete study consi sting of T-1-weighted sagittal images, T-2-weighted sagittal images, and T- 1- and/or T-2-weighted axial images) and 94 T-1-weighted sagittal images al one (a subset of the complete studies) from 57 consecutive cancer patients over the last 2 years with clinically suspected cord compression were blind ly and independently evaluated by four radiologists. The complete MR studie s were used as the standard. Overall, the sensitivity of T-1-weighted sagit tal images alone to vertebral metastasis (87%) was statistically greater th an cord compression (70%) (p = 0.05). and statistically greater than epidur al metastasix (46%) (p less than or equal to 0.02). The specificity for cor d compression (97%) was greater than the specificity for epidural metastasi s (89%) (p = 0.03), and greater than the specificity for vertebral metastas is (83%) (p less than or equal to 0.02). There was a strong trend Fur bette r detection of cord compression overall and better detection of vertebral m etastasis in the cervical spine by the most experienced radiologist. Comple te studies of the spine are necessary in the diagnosis of vertebral metasta sis, epidural metastasis. and cord compression. particularly with less expe rienced radiologists. (C) 2000 Elsevier Science inc. All rights reserved.