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Neuroradiology| Volume 55, P165-173, May 2019

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Diagnosis of spinal metastasis: are MR images without contrast medium application sufficient?

  • Chankue Park
    Affiliations
    Department of Radiology, Pusan National University Yangsan Hospital, 20, Geumo-ro, Mulgeum-eup, Yangsan-si, Gyeongsananam-do, Republic of Korea
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  • Joon Woo Lee
    Correspondence
    Corresponding author at: Department of Radiology, Seoul National University Bundang Hospital, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do 13620, Republic of Korea.
    Affiliations
    Department of Radiology, Seoul National University Bundang Hospital, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea
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  • Yongju Kim
    Affiliations
    Department of Radiology, Seoul National University Bundang Hospital, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea
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  • Soyeon Ahn
    Affiliations
    Division of Statistics, Medical Research Collaborating Center, Seoul National University Bundang Hospital, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea.
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  • Eugene Lee
    Affiliations
    Department of Radiology, Seoul National University Bundang Hospital, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea
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  • Yusuhn Kang
    Affiliations
    Department of Radiology, Seoul National University Bundang Hospital, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea
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  • Heung Sik Kang
    Affiliations
    Department of Radiology, Seoul National University Bundang Hospital, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea
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      Highlights

      • CE-MRI is useful for evaluation of spinal segments with metastases in 39–53% of cases.
      • CE-MRI is useful in characterization and detection of spinal metastases.
      • CE-MR imaging is less useful in disseminated spinal metastases.

      Abstract

      Objective

      To determine the usefulness of adding contrast-enhanced (CE) magnetic resonance imaging (MRI) to conventional MRI for evaluation of spinal metastases.

      Materials and methods

      One-hundred-and-two whole spine MR examinations, obtained for metastasis work-up within a 2-month period, from 65 men and 37 women (mean age, 64 years) with extra-spinal tumor, who also underwent CE-MRI, were retrospectively evaluated by three radiologists. The number of spine segments with bone marrow involvement was interpreted using a 3-point confidence scale (probable metastasis, equivocal, probably benign) during session 1 (conventional imaging) and session 2 (addition of CE-MRI to conventional imaging). The patients were assigned to 14 categories based on the changes in confidence rating between sessions 1 and 2; these were aggregated to four groups indicating the degree of usefulness of CE-MRI: definitely useful, equivocal, not useful, and presumed non-metastatic groups. Clinical information, metastatic bone type, the number of probably metastatic segments, and anatomical level and position were compared among the former three groups.

      Results

      The readers assigned 39–53% of cases to the definitely useful group. The number of probably metastatic segments differed significantly among the three groups for all readers (p ≤ 0.046). Age, sex, primary cancer, metastatic bone type, and anatomical level and position were similar.

      Conclusion

      Adding CE-MRI to conventional MRI was useful for objectively detecting and characterizing spinal segments with metastases in 39–53% of cases. However, there were no clinical or radiological factors that could predict the usefulness of CE-MRI in evaluating spinal metastases, except for the number of metastatic segments.

      Keywords

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      References

        • Bohm P.
        • Huber J.
        The surgical treatment of bony metastases of the spine and limbs.
        J Bone Joint Surg Br. 2002; 84: 521-529
        • Witham T.F.
        • Khavkin Y.A.
        • Gallia G.L.
        • Wolinsky J.P.
        • Gokaslan Z.L.
        Surgery insight: current management of epidural spinal cord compression from metastatic spine disease.
        Nat Clin Pract Neurol. 2006; 2 ([quiz 116]): 87-94
        • Perrin R.G.
        Metastatic tumors of the axial spine.
        Curr Opin Oncol. 1992; 4: 525-532
        • Keogh C.
        • Bergin D.
        • Brennan D.
        • Eustace S.
        MR imaging of bone tumors of the cervical spine.
        Magn Reson Imaging Clin N Am. 2000; 8: 513-528
        • Abdel Razek A.A.
        • Castillo M.
        Imaging appearance of primary bony tumors and pseudo-tumors of the spine.
        J Neuroradiol. 2010; 37: 37-50
        • Avrahami E.
        • Tadmor R.
        • Dally O.
        • Hadar H.
        Early MR demonstration of spinal metastases in patients with normal radiographs and CT and radionuclide bone scans.
        J Comput Assist Tomogr. 1989; 13: 598-602
        • Algra P.R.
        • Bloem J.L.
        • Tissing H.
        • Falke T.H.
        • Arndt J.W.
        • Verboom L.J.
        Detection of vertebral metastases: comparison between MR imaging and bone scintigraphy.
        Radiographics. 1991; 11: 219-232
        • Smoker W.R.
        • Godersky J.C.
        • Knutzon R.K.
        • Keyes W.D.
        • Norman D.
        • Bergman W.
        The role of MR imaging in evaluating metastatic spinal disease.
        AJR Am J Roentgenol. 1987; 149: 1241-1248
      1. Roberts CC, Daffner RH, Weissman BN, Bancroft L, Bennett DL, Blebea JS, et al. ACR appropriateness criteria on metastatic bone disease. J Am Coll Radiol 2010;7:400–409.

      2. Patel ND, Broderick DF, Burns J, Deshmukh TK, Fries IB, Harvey HB, et al. ACR appropriateness criteria low back pain. J Am Coll Radiol 2016;13:1069–1078.

        • Johnson A.J.
        • Ying J.
        • El Gammal T.
        • Timmerman R.D.
        • Kim R.Y.
        • Littenberg B.
        Which MR imaging sequences are necessary in determining the need for radiation therapy for cord compression? A prospective study.
        AJNR Am J Neuroradiol. 2007; 28: 32-37
      3. Mahnken AH, Wildberger JE, Adam G, Stanzel S, Schmitz-Rode T, Gunther RW, et al. Is there a need for contrast-enhanced T1-weighted MRI of the spine after inconspicuous short tau inversion recovery imaging? Eur Radiol 2005;15:1387–1392.

      4. Khadem NR, Karimi S, Peck KK, Yamada Y, Lis E, Lyo J, et al. Characterizing hypervascular and hypovascular metastases and normal bone marrow of the spine using dynamic contrast-enhanced MR imaging. AJNR Am J Neuroradiol 2012;33:2178–2185.

        • Stimac G.K.
        • Porter B.A.
        • Olson D.O.
        • Gerlach R.
        • Genton M.
        Gadolinium-DTPA-enhanced MR imaging of spinal neoplasms: preliminary investigation and comparison with unenhanced spin-echo and STIR sequences.
        AJR Am J Roentgenol. 1988; 151: 1185-1192
        • Lim V.
        • Sobel D.F.
        • Zyroff J.
        Spinal cord pial metastases: MR imaging with gadopentetate dimeglumine.
        AJR Am J Roentgenol. 1990; 155: 1077-1084
        • Sze G.
        • Krol G.
        • Zimmerman R.D.
        • Deck M.D.
        Malignant extradural spinal tumors: MR imaging with Gd-DTPA.
        Radiology. 1988; 167: 217-223
      5. Bilsky MH, Laufer I, Fourney DR, Groff M, Schmidt MH, Varga PP, et al. Reliability analysis of the epidural spinal cord compression scale. J Neurosurg Spine 2010;13:324–328.

      6. . Fisher CG, DiPaola CP, Ryken TC, Bilsky MH, Shaffrey CI, Berven SH, et al. A novel classification system for spinal instability in neoplastic disease: an evidence-based approach and expert consensus from the spine oncology study group. Spine (Phila Pa 1976) 2010;35:E1221–9.

        • Landis J.R.
        • Koch G.G.
        The measurement of observer agreement for categorical data.
        Biometrics. 1977; 33: 159-174
        • Shah L.M.
        • Salzman K.L.
        Imaging of spinal metastatic disease.
        Int J Surg Oncol. 2011; 2011769753
        • Georgy B.A.
        Metastatic spinal lesions: state-of-the-art treatment options and future trends.
        AJNR Am J Neuroradiol. 2008; 29: 1605-1611
        • Bilsky M.H.
        • Lis E.
        • Raizer J.
        • Lee H.
        • Boland P.
        The diagnosis and treatment of metastatic spinal tumor.
        Oncologist. 1999; 4: 459-469
        • Jacobs W.B.
        • Perrin R.G.
        Evaluation and treatment of spinal metastases: an overview.
        Neurosurg Focus. 2001; 11: e10
      7. Dong Y, Zheng S, Machida H, Wang B, Liu A, Liu Y, et al. Differential diagnosis of osteoblastic metastases from bone islands in patients with lung cancer by single-source dual-energy CT: advantages of spectral CT imaging. Eur J Radiol 2015;84:901–907.

        • Lang N.
        • Su M.Y.
        • Yu H.J.
        • Lin M.
        • Hamamura M.J.
        • Yuan H.
        Differentiation of myeloma and metastatic cancer in the spine using dynamic contrast-enhanced MRI.
        Magn Reson Imaging. 2013; 31: 1285-1291
        • Pozzi G.
        • Garcia Parra C.
        • Stradiotti P.
        • Tien T.V.
        • Luzzati A.
        • Zerbi A.
        Diffusion-weighted MR imaging in differentiation between osteoporotic and neoplastic vertebral fractures.
        Eur Spine J. 2012; 21: S123-S127
        • Razek A.A.K.A.
        • Ashmalla G.A.
        Assessment of paraspinal neurogenic tumors with diffusion-weighted MR imaging.
        Eur Spine J. 2018; 27: 841-846
        • Kim J.K.
        • Learch T.J.
        • Colletti P.M.
        • Lee J.W.
        • Tran S.D.
        • Terk M.R.
        Diagnosis of vertebral metastasis, epidural metastasis, and malignant spinal cord compression: are T(1)-weighted sagittal images sufficient?.
        Magn Reson Imaging. 2000; 18: 819-824
        • Meyer J.S.
        • Siegel M.J.
        • Farooqui S.O.
        • Jaramillo D.
        • Fletcher B.D.
        • Hoffer F.A.
        Which MRI sequence of the spine best reveals bone-marrow metastases of neuroblastoma?.
        Pediatr Radiol. 2005; 35: 778-785
      8. Sung JK, Jee WH, Jung JY, Choi M, Lee SY, Kim YH, et al. Differentiation of acute osteoporotic and malignant compression fractures of the spine: use of additive qualitative and quantitative axial diffusion-weighted MR imaging to conventional MR imaging at 3.0 T. Radiology 2014;271:488–498.

      9. Nakanishi K, Kobayashi M, Nakaguchi K, Kyakuno M, Hashimoto N, Onishi H, et al. Whole-body MRI for detecting metastatic bone tumor: diagnostic value of diffusion-weighted images. Magn Reson Med Sci 2007;6:147–155.