title: Intramedullary spinal cord metastases: MRI and relevant clinical features from a 13-year institutional case series.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of Neuroradiology, Department of Radiology.
authors.forename: J B
authors.initials: JB
authors.lastname: Rykken
authors.forename: F E
authors.initials: FE
authors.lastname: Diehn
authors.forename: C H
authors.initials: CH
authors.lastname: Hunt
authors.forename: K M
authors.initials: KM
authors.lastname: Schwartz
authors.forename: L J
authors.initials: LJ
authors.lastname: Eckel
authors.forename: C P
authors.initials: CP
authors.lastname: Wood
authors.forename: T J
authors.initials: TJ
authors.lastname: Kaufmann
authors.forename: R K
authors.initials: RK
authors.lastname: Lingineni
authors.forename: R E
authors.initials: RE
authors.lastname: Carter
authors.forename: J T
authors.initials: JT
authors.lastname: Wald
mesh_terms: D000230:Adenocarcinoma / Q000556:secondary; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000473:pathology; D018278:Carcinoma, Neuroendocrine / Q000556:secondary*; D002648:Child; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology; D008223:Lymphoma / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000473:pathology; D011471:Prostatic Neoplasms / Q000473:pathology; D012189:Retrospective Studies; D012468:Salivary Gland Neoplasms / Q000473:pathology*; D013120:Spinal Cord Neoplasms / Q000556:secondary*; D065646:Thyroid Carcinoma, Anaplastic; D013964:Thyroid Neoplasms / Q000473:pathology*; D055815:Young Adult