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 disease in patients with known malignancy using magnetic resonance imaging (MRI). MATERIALS AND METHODS: One hundred and fifty-five patients underwent a total of 159 spinal MRI examinations over a three-year period. Patients were examined using a 1.0T magnet and a phased array surface spine coil. Sagittal T1 weighted spin echo and STIR sequences were routinely employed. Axial T1 and T2 weighted spin echo images were obtained at sites of identified pathology. Contrast enhanced sagittal and axial T1 weighted spin echo images were acquired when the unenhanced appearances did not correlate with the clinical findings or when the images suggested intradural or intramedullary disease. RESULTS: Malignant disease affecting the spinal cord or cauda equina was noted in 104/159 (65%) patients (extradural n= 78, intradural n= 20, intramedullary n= 7); one patient had evidence of both intradural and intramedullary deposits. Multiple levels of extradural cord/cauda equina compression were present in 18/78 patients (23%). The thoracic spine was the most frequently affected (74%). Bone elements were the major component of extradural compression in 11/78 patients (14%). Intradural metastases were multiple in 15/20 patients (75%). Four of the six solitary intramedullary metastases were situated in the conus medullaris. CONCLUSION: Magnetic resonance imaging of the entire spine is the investigation of choice in patients with known malignancy and suspected spinal canal disease. Contrast-enhanced images should be acquired when the unenhanced appearances do not correlate with the clinical findings or when they suggest intradural or intramedullary disease.Loughrey, G. J. (2000). Clinical Radiology55, 849-855.

The value of specialist oncological radiology review of cross-sectional imaging.

AIM: To determine whether specialist oncological radiology review of outside cross-sectional imaging affects patient management. MATERIALS AND METHODS: Five hundred and twenty-six patients attending a regional oncology centre had review of outside cross-sectional imaging over a 1-year period. The number of examinations per patient, time interval between examination and review request, and examination technical adequacy were recorded in each case. More detailed evaluation of 124 patients included comparison of outside and review reports for major differences in interpretation by a medical oncologist who also evaluated the effect of the review on patient management. Examinations resulting in major report discrepancies were subjected to independent radiological adjudication. RESULTS: Eighty-one percent of examinations were reviewed within 3 months of being performed and 94% were considered technically adequate. The hard copy images provided were incomplete in 33% of cases and a calibration rule was absent in 9%. There was a major difference in interpretation in 34% of examinations, the most common cause being differences in interpretation of lymphadenopathy (52%), particularly in the mediastinum (19%). Other problems identified were the failure to record disease dimensions and absence of specific information on key organs in the outside reports. Specialist radiology review changed radiological staging in 19% of patients, affected management in 7% of patients and resulted in a change in treatment in 4%. There was no correlation between management change and any particular tumour type. In 27% of cases, treatment decisions had been made before the review was requested. CONCLUSION: Specialist oncological radiology review of outside cross-sectional imaging changed radiological staging in 19% of cases but had little impact on patient management. Oncological cross-sectional imaging techniques in the North West of England are of high quality, probably helped by recent RCR guidelines.