[Contribution of magnetic resonance imaging in the early diagnosis of epidural metastasis].

BACKGROUND

Vertebral bone metastases represent the most frequently affected region within the skeleton. They are of important relevance because of the risk of medullar compression. The diagnosis of medullar canal invasion is of particular interest in order to prevent neurological dysfunction. A prospective study was carried out to detect the frequency and degree of invasion of the spine.

METHODS

Twenty-eight patients were studied (13 males and 15 females), with a median age of 61 years (range 35-85), with cancer diagnosis and vertebral bone metastases, and local or radicular pain, without signs or symptoms suggesting myelopathy. Neurological, physical examination, radiological study (anteroposterior and lateral) and magnetic resonance imaging (MRI) study was performed in all patients to detect medullar canal invasion.

RESULTS

Local pain was present in 43% of patients (n = 12), and radicular in 57.1% (n = 16). The most frequent radiologic vertebral involvement was thoracic (46.4%), with 71% of vertebral body collapse. MRI showed epidural space invasion in 75% of patients (n = 21), with a degree superior to 50% in 43%.

CONCLUSIONS

The beginning of vertebral pain in a patient with cancer diagnosis, with evidence of bone invasion after radiological study, represents a major indicator to perform a MRI study to detect epidural involvement.