Intramedullary spinal cord metastases: prognostic value of MRI and clinical features from a 13-year institutional case series.
OBJECTIVE
In patients with intramedullary spinal cord metastases, the impact of MR imaging and clinical characteristics on survival has not been elucidated. Our aim was to identify MR imaging and clinical features with prognostic value among patients with intramedullary spinal cord metastases from a large retrospective series.


METHODS
The relevant MR imaging examination and baseline clinical data for each patient from a consecutive group of patients with intramedullary spinal cord metastases had previously been reviewed by 2 neuroradiologists. Additional relevant clinical data were extracted. The influence of clinical and imaging characteristics on survival was assessed by Kaplan-Meier survival curves and log-rank tests for categoric characteristics.


RESULTS
Forty-nine patients had 70 intramedullary spinal cord metastases; 10 (20%) of these patients had multiple metastases. From the date of diagnosis, median survival for all patients was 104 days (95% CI, 48-156 days). One clinical feature was associated with decreased median survival: lung or breast primary malignancy (57 days) compared with all other malignancy types (308 days; P < .001). Three MR imaging features were associated with decreased median survival: multiple intramedullary spinal cord metastases (53 versus 121 days, P = .022), greater longitudinal extent of cord T2 hyperintensity (if ≥3 segments, 111 days; if ≤2, 184 days; P = .018), and ancillary visualization of the primary tumor and/or non-CNS metastases (96 versus 316 days, P = .012).


CONCLUSIONS
Spinal cord edema spanning multiple segments, the presence of multifocal intramedullary spinal cord metastases, and ancillary evidence for non-CNS metastases and/or the primary tumor are MR imaging features associated with decreased survival and should be specifically sought. Patients with either a lung or breast primary malignancy are expected to have decreased survival compared with other primary tumor types.
From the Division of Neuroradiology (F.E.D., J.B.R., J.T.W., C.P.W., L.J.E., C.H.H., K.M.S., T.J.K.), Department of Radiology diehn.felix@mayo.edu.
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Diehn
From the Division of Neuroradiology (F.E.D., J.B.R., J.T.W., C.P.W., L.J.E., C.H.H., K.M.S., T.J.K.), Department of Radiology.
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JB
Rykken
From the Division of Neuroradiology (F.E.D., J.B.R., J.T.W., C.P.W., L.J.E., C.H.H., K.M.S., T.J.K.), Department of Radiology.
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JT
Wald
From the Division of Neuroradiology (F.E.D., J.B.R., J.T.W., C.P.W., L.J.E., C.H.H., K.M.S., T.J.K.), Department of Radiology.
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CP
Wood
From the Division of Neuroradiology (F.E.D., J.B.R., J.T.W., C.P.W., L.J.E., C.H.H., K.M.S., T.J.K.), Department of Radiology.
L J
LJ
Eckel
From the Division of Neuroradiology (F.E.D., J.B.R., J.T.W., C.P.W., L.J.E., C.H.H., K.M.S., T.J.K.), Department of Radiology.
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CH
Hunt
From the Division of Neuroradiology (F.E.D., J.B.R., J.T.W., C.P.W., L.J.E., C.H.H., K.M.S., T.J.K.), Department of Radiology.
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KM
Schwartz
Department of Health Sciences Research (R.K.L., R.E.C.), Mayo Clinic, Rochester, Minnesota.
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RK
Lingineni
Department of Health Sciences Research (R.K.L., R.E.C.), Mayo Clinic, Rochester, Minnesota.
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RE
Carter
From the Division of Neuroradiology (F.E.D., J.B.R., J.T.W., C.P.W., L.J.E., C.H.H., K.M.S., T.J.K.), Department of Radiology.
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TJ
Kaufmann
D000368:Aged; D001943:Breast Neoplasms / Q000473:pathology; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008175:Lung Neoplasms / Q000473:pathology; D008279:Magnetic Resonance Imaging / Q000379:methods; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D013120:Spinal Cord Neoplasms / Q000175:diagnosis / Q000401:mortality* / Q000556:secondary*