MRI and clinical assessment of patients with symptomatic spinal metastases

摘要

Spinal metastases are frequent manifestations of systemic neoplasia, and the vertebral column is one of the most common sites of skeletal metastases. Bone metastases often cause severe pain and may cause pathological fractures and metastatic spinal cord compression (MSCC). External beam radiotherapy (RT) is frequently used as the primary treatment modality for patients with spinal metastatic disease. Magnetic resonance imaging (MRI) is considered the most specific and sensitive method for imaging spinal metastases and is the primary investigation for suspected MSCC.In two different studies, the association between pretreatment neurological status and MRI findings, and the association between post treatment pain response and MRI findings was explored. In the third study, we assessed whether clinical, laboratory and MRI parameters were predictive factors for survival in patients with spinal metastases. The studies showed that the pretreatment degree of MSCC at MRI was significantly associated with the severity of neurological symptoms. We also identified a considerable number of patients with subclinical MSCC, which is important because identifying MSCC early is critical to prevent irreversible neurological deterioration. Furthermore, RT was shown to provide an effective local control of spinal metastases. The pain response rate to treatment did not differ in patients with and without pathological fractures, MSCC or any other recorded MRI findings. Lastly, our results confirmed that primary tumor histology and performance status were the major prognostic factors for survival in patients with spinal metastases and normal neurological function. Importantly, MRIbased extent of spinal metastatic disease had no impact on survival. The pretreatment albumin level was an important predictive factor that should be considered when analyzing survival in these patients.