Neuroimaging and treatment implications of patients with multiple epidural spinal metastases

David Schiff, B. P. O'Neill, Chiao Hua Wang, Judith R. O'Fallon

Research output: Contribution to journalArticlepeer-review

87 Scopus citations

Abstract

BACKGROUND. Although multiple spinal epidural metastases (MEMs) commonly occur in cancer patients, their clinical significance remains uncertain. The authors attempted to ascertain the incidence of MEMs and their association with the completeness of spinal imaging by magnetic resonance (MR) scanning versus myelography to determine how often they are missed because of incomplete spinal imaging and to assess their prognostic and treatment implications. METHODS. A review of 337 epidural spinal cord compression (ESCC) cases seen at the Mayo Clinic between 1985 and 1903 was conducted. RESULTS. ESCC patients undergoing myelography only were significantly more likely to undergo complete spinal imaging (CSI)than patients undergoing either MR scan only or both imaging modalities (P < 0.0001). MEMs were detected in 32% of patients undergoing CSI and 18% of patients with incomplete spinal imaging (P = 0.02). Failure to image the cervical spine in patients with symptomatic thoracic or lumbar epidural lesions would have missed secondary epidural lesions in only 1% of patients; however, this figure increased to 21% for failure to image either the thoracic or lumbosacral spine when symptomatic disease was located elsewhere. Radiation oncologists included secondary epidural deposits in treatment ports in 93% of MEM cases. In a multivariate model, the presence of MEMs was an independent prognostic factor for poorer survival. CONCLUSION. The incidence of MEMs in patients with ESCC is approximately 30%, and their presence frequently alters treatment plans it appears safe to forgo cervical spine MR scanning in patients with radiographically verified thoracic or lumbar ESCC; however, careful imaging of the thoracic and lumbar spine should be considered in all ESCC patients to detect MEMs.

Original languageEnglish (US)
Pages (from-to)1593-1601
Number of pages9
JournalCancer
Volume83
Issue number8
DOIs
StatePublished - Oct 15 1998

Keywords

  • Epidural neoplasms
  • Human
  • Magnetic resonance imaging
  • Myelography
  • Neoplasms
  • Prognosis
  • Retrospective studies
  • Spinal cord compression
  • Spinal cord neoplasms

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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