Investig Magn Reson Imaging.  2016 Mar;20(1):1-8. 10.13104/imri.2016.20.1.1.

Interpretation of MR Imaging of Spinal Metastasis: Focus on the Understanding of Its Pathophysiology and the Next Step toward a Further Clinical Approach Using MRI Findings

• Lee KR

• KMID: 2161365
• DOI: http://doi.org/10.13104/imri.2016.20.1.1

Abstract

The spine is the most common location for skeletal metastases, and the incidence of spinal metastasis shows an increasing tendency. Because metastatic spinal tumors progress from an anterior element to a posterior element resulting in continuing destruction of the pedicles, epidural extension and involvement of neural structures of the metastatic tumor are eventually visible. Therefore, it is clinically significant for radiologists to understand the pathophysiology of spinal metastasis and to assess the involvement of neural structures and the disintegration of spinal instability related to the pathophysiology. As MRI is also the best imaging modality for diagnosing spinal metastasis, radiologists should accurately assess spinal metastasis and provide practical information to physicians. Therefore, we will describe some analysis points focusing on the understanding of pathophysiology of spinal metastasis and the next step toward a more extensive clinical approach using MR imaging.

Keyword

Spine; Metastasis; Magnetic resonance imaging

MeSH Terms

Incidence
Magnetic Resonance Imaging*
Neoplasm Metastasis*
Spine

Figure

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  Fig. 1 Tumor in the vertebral body: The tumor is anterior to the spinal cord and grows posteriorly to compress the spinal cord (6). Reprinted with permission from (6): Cole JS, Patchell RA. Metastatic epidural spinal cord compression. Lancet Neurol 2008;7:459-466.

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  Fig. 2 Schematic diagram of the surgical classification of spinal tumors, from Choi et al. (1). Reprinted with permission from: Choi D, Crockard A, Bunger C, et al. Review of metastatic spine tumour classification and indications for surgery: the consensus statement of the Global Spine Tumour Study Group. Eur Spine J 2010;19:215-222.

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  Fig. 3 Intracompartmental bone metastasis: 68-year-old woman consulting for breast cancer. Sagittal gadolinium-enhanced T1-weighted (TR/TE; 550/7) image with fat saturation (a) and axial gadolinium-enhanced T1-weighted (TR/TE; 455/10) image with fat saturation (b) show C7 metastasis contained within vertebral body.

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  Fig. 4 Extracompartmental bone metastasis: 58-year-old man consulting for hepatocellular carcinoma. Sagittal gadolinium-enhanced T1-weighted (TR/TE; 711/11) image with fat saturation (a), axial T2-weighted (TR/TE; 5063/89) image (b) and axial gadolinium-enhanced T1-weighted (TR/TE; 741/11) image with fat saturation (c) show T7 metastasis out of the bones of T7 extending to epidural and a paravertebral space.

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  Fig. 5 Metastases in multiple vertebral levels: 42-year-old woman visiting for sigmoid colon cancer and both inguinal pain. Sagittal T1-weighted (TR/TE; 496/10) image (a), sagittal T2-weighted (TR/TE; 3832/100) image (b) and sagittal gadolinium-enhanced T1-weighted (TR/TE; 460/10) image with fat saturation (c) show multiple vertebral involvement of bone metastasis in L1-L5 and bodies of S1 and S2.

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  Fig. 6 Neural compression: 59-year-old man with esophageal cancer visited for weakness of both lower extremities. Sagittal T1-weighted (TR/TE; 661/10) image (a), sagittal T2-weighted (TR/TE; 2347/120) image (b), sagittal gadolinium-enhanced T1-weighted (TR/TE; 557/8) image with fat saturation (c), axial gadolinium-enhanced T1-weighted (TR/TE; 483/10) image with fat saturation (d), axial T2-weighted (TR/TE; 3262/115) image (e) show bone metastasis in T1 and T2 associated with pathologic compression fracture and epidural extension (empty arrows) of the metastatic tumor resulting in compromise of spinal canal and compression of spinal cord. And sagittal and axial T2-weighted images also show high signal change in spinal cord of C7-T4 level suggesting compressive myelopathy (arrows).

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  Fig. 7 Spinal instability: 51-year-old woman with breast cancer visiting for detection of metastasis in T7, but she did not complain of severe pain. Sagittal T2-weighted (TR/TE; 3500/100) image (a) shows bone metastasis and pathologic compression fracture without spinal cord compression. She treated by palliative radiation therapy for T7. However, two years later, in follow-up study, sagittal T2-weighted (TR/TE; 3500/120) image (b) shows more decreased height of T7 and compression of spinal cord in T7 level.

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  Fig. 8 Special cases: Leptomeingeal metastasis: 43-year-old woman with breast cancer complained of weakness and pain in both lower extremities. Sagittal T1-weighted (TR/TE; 661/10) image of C-T spine (a), sagittal T2-weighted (TR/TE; 2239/120) image of C-T spine (b) and sagittal gadolinium-enhanced T1-weighted (TR/TE; 448/10) image with fat saturation image of L-spine (c) show multiple bone metastases in the whole spine, and thick enhancement of leptomeninges from L5 to S2 suggesting leptomeningeal metastasis (arrows). Leptomeningeal metastasis is proven by CSF study.

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