Abstract
Because intramedullary spinal cord metastasis is often a difficult diagnosis to make, our purpose was to perform a systematic review of the MR imaging and relevant baseline clinical features of intramedullary spinal cord metastases in a large series. Consecutive patients with intramedullary spinal cord metastasis with available pretreatment digital MR imaging examinations were identified. The MR imaging examination(s) for each patient was reviewed by 2 neuroradiologists for various imaging characteristics. Relevant clinical data were obtained. Forty-nine patients had 70 intramedullary spinal cord metastases, with 10 (20%) having multiple intramedullary spinal cord metastases; 8% (4/49) were asymptomatic. Primary tumor diagnosis was preceded by intramedullary spinal cord metastasis presentation in 20% (10/49) and by intramedullary spinal cord metastasis diagnosis in 10% (5/49); 98% (63/64) of intramedullary spinal cord metastases enhanced. Cord edema was extensive: mean, 4.5 segments, 3.6-fold larger than enhancing lesion, and ≥3 segments in 54% (37/69). Intratumoral cystic change was seen in 3% (2/70) and hemorrhage in 1% (1/70); 59% (29/49) of reference MR imaging examinations displayed other CNS or spinal (non-spinal cord) metastases, and 59% (29/49) exhibited the primary tumor/non-CNS metastases, with 88% (43/49) displaying ≥1 finding and 31% (15/49) displaying both findings. Patients with solitary intramedullary spinal cord metastasis were less likely than those with multiple intramedullary spinal cord metastases to have other CNS or spinal (non-spinal cord) metastases on the reference MR imaging (20/39 [51%] versus 9/10 [90%], respectively; P = .0263). Lack of known primary malignancy or spinal cord symptoms should not discourage consideration of intramedullary spinal cord metastasis. Enhancement and extensive edema for lesion size (often ≥3 segments) are typical for intramedullary spinal cord metastasis. Presence of cystic change/hemorrhage makes intramedullary spinal cord metastasis unlikely. Evidence for other CNS or spinal (non-spinal cord) metastases and the primary tumor/non-CNS metastases are common. The prevalence of other CNS or spinal (non-spinal cord) metastases in those with multiple intramedullary spinal cord metastases is especially high.
Highlights
BACKGROUND AND PURPOSEBecause intramedullary spinal cord metastasis is often a difficult diagnosis to make, our purpose was to perform a systematic review of the MR imaging and relevant baseline clinical features of intramedullary spinal cord metastases in a large series
Primary tumor diagnosis was preceded by intramedullary spinal cord metastasis presentation in 20% (10/49) and by intramedullary spinal cord metastasis diagnosis in 10% (5/49); 98% (63/64) of intramedullary spinal cord metastases enhanced
Intratumoral cystic change was seen in 3% (2/70) and hemorrhage in 1% (1/70); 59% (29/49) of reference MR imaging examinations displayed other CNS or spinal metastases, and 59% (29/49) exhibited the primary tumor/non-CNS metastases, with 88% (43/49) displaying Ն1 finding and 31% (15/49) displaying both findings
Summary
Consecutive patients with intramedullary spinal cord metastasis with available pretreatment digital MR imaging examinations were identified. Patients without pretreatment digital MR imaging examination, patients in whom alternative diagnoses were suspected clinically, and patients in whom ISCM was never formally diagnosed were excluded These 58 patients with ISCM were the basis for a recent study, which described 2 specific enhancement features on postgadolinium MR imaging in ISCMs compared with primary cord masses.[7] Five (9%) of these 58 patients were excluded for the current (and the prior) study because of the lack of available pretreatment MR imaging examination. Only patients with a clinical diagnosis of ISCM were included on the basis of review of all available clinical, pathologic, and imaging data This yielded a final ISCM study population of 49 (92%) of the remaining 53 patients, with a total of 70 ISCMs. In 5 (10%) of these 49 patients with ISCM, the diagnosis of a solitary ISCM was confirmed by cord mass biopsy/resection. In an additional 44 (90%) of the 49 patients with ISCM, “pathologic proof of the systemic malignancy had been obtained from the primary site or a metastatic site outside of the spinal cord.” One (2%) of the patients died “before any sampling but was clinically presumed to have an ISCM from lung carcinoma, given a classic radiographic pattern of dominant primary lung mass, with multiple pulmonary metastases, hilar and mediastinal adenopathy, distant metastases, a pack-year smoking history, and a family history of lung cancer.”[7]
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