Magnetic resonance imaging in the management of suspected spinal canal disease in patients with known malignancy

AIM: The aim of this study was to examine the spectrum of spinal canal dise ase in patients with known malignancy using magnetic resonance imaging (MRI ). MATERIALS AND METHODS: One hundred and fifty-five patients underwent a tota l of 159 spinal MRI examinations over a three-year period. Patients were ex amined using a 1.0T magnet and a phased array surface spine coil. Sagittal Ti weighted spin echo and STIR sequences were routinely employed. Axial T1 and T2 weighted spin echo images were obtained at sites of identified patho logy. Contrast enhanced sagittal and axial T1 weighted spin echo images wer e acquired when the unenhanced appearances did not correlate with the clini cal findings or when the images suggested intradural or intramedullary dise ase. RESULTS: Malignant disease affecting the spinal cord or cauda equina was no ted in 104/159 (65%) patients (extradural n = 78, intradural II = 20, intra medullary n = 7); one patient had evidence of both intradural and intramedu llary deposits. Multiple levels of extradural cord/cauda equina compression were present in 18/78 patients (23%). The thoracic spine was the most freq uently affected (74%). Bone elements were the major component of extradural compression in 11/78 patients (14%). Intradural metastases were multiple i n 15/20 patients (75%). Pour of the six solitary intramedullary metastases were situated in the conus medullaris. CONCLUSION: Magnetic resonance imaging of the entire spine is the investiga tion of choice in patients crith known malignancy and suspected spinal cana l disease. Contrast-enhanced images should be acquired when the unenhanced appearances do not correlate with the clinical findings or when they sugges t intradural or intramedullary disease. (C) 2000 The Royal College of Radio logists.