title: MRI and neurological findings in patients with spinal metastases.
abstract: BACKGROUND
  Magnetic resonance imaging (MRI) is the recommended primary investigation method for metastatic spinal cord compression (MSCC). Initiating treatment before the development of motor deficits is essential to preserve neurological function. However, the relationship between MRI-assessed grades of spinal metastatic disease and neurological status has not been widely investigated.
  
  
  OBJECTIVE
  To analyze the association between neurological function and MRI-based assessment of the extent of spinal metastases using two different grading systems.
  
  
  METHODS
  A total of 284 patients admitted to our institution for initial radiotherapy or surgery for symptomatic spinal metastases were included in the study. Motor and sensory deficits were categorized according to the Frankel classification system. Pre-treatment MRI evaluations of the entire spine were scored for the extent of spinal metastases, presence and severity of spinal cord compression, and nerve root compression. Two MRI-based scales were used to evaluate the degree of cord compression and spinal canal narrowing and relate these findings to neurological function.
  
  
  RESULTS
  Of the patients included in the study, 28 were non-ambulatory, 49 were ambulatory with minor motor deficits, and 207 had normal motor function. Spinal cord compression was present in all patients with Frankel scores of B or C, 23 of 35 patients with a Frankel score of D (66%), and 48 of 152 patients with a Frankel score of E (32%). The percentage of patients with severe spinal canal narrowing increased with increasing Frankel grades. The grading according to the scales showed a significant association with the symptoms according to the Frankel scale (P < 0.001).
  
  
  CONCLUSIONS
  In patients with neurological dysfunction, the presence and severity of impairment was associated with the epidural tumor burden. A significant number of patients had radiological spinal cord compression and normal motor function (occult MSCC).
authors.affiliation: Department of Radiology and Nuclear Medicine, Oslo University Hospital, Norwegian Radium Hospital, Norway. marta.switlyk@radiumhospitalet.no
authors.forename: M D
authors.initials: MD
authors.lastname: Switlyk
authors.forename: K H
authors.initials: KH
authors.lastname: Hole
authors.forename: S
authors.initials: S
authors.lastname: Skjeldal
authors.forename: J K
authors.initials: JK
authors.lastname: Hald
authors.forename: K
authors.initials: K
authors.lastname: Knutstad
authors.forename: T
authors.initials: T
authors.lastname: Seierstad
authors.forename: O
authors.initials: O
authors.lastname: Zaikova
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004824:Epidural Space / Q000473:pathology; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D009460:Neurologic Examination / Q000379:methods / Q000706:statistics & numerical data; D011446:Prospective Studies; D012720:Severity of Illness Index; D013115:Spinal Canal / Q000473:pathology; D013117:Spinal Cord Compression / Q000473:pathology; D013125:Spinal Neoplasms / Q000175:diagnosis* / Q000556:secondary; D013131:Spine / Q000473:pathology; D055815:Young Adult