Godersky J C, Smoker W R, Knutzon R
Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City.
Neurosurgery. 1987 Nov;21(5):676-80. doi: 10.1227/00006123-198711000-00013.
Spinal metastases are present in up to 10% of all cancer patients at some time during the course of their disease. Pain is the most common presenting symptom, and neurological function is usually normal at this early stage. The clinical challenge is to detect and treat the spinal disease before the onset of neurological compromise. Myelography has been the standard test for identification of epidural metastases, but the invasive nature of myelography carries inherent risk and produces patient discomfort. Magnetic resonance imaging (MRI) has been useful in the evaluation of other spinal diseases, is noninvasive, and is tolerated well by patients. We evaluated and compared MRI (64 studies in 58 patients) to conventional studies (myelography, computed tomography, bone scanning, plain films) and determined its accuracy in diagnosis and efficacy in clinical decision making. MRI proved superior in detecting bone and epidural involvement by tumor and was valuable in clinical decision making. In addition, MRI provided better visualization of paravertebral soft tissue involvement by tumor. MRI is recommended as the initial study in patients with suspected metastatic spinal disease.
在所有癌症患者病程中的某个阶段，脊柱转移瘤的发生率高达10%。疼痛是最常见的首发症状，在疾病早期神经功能通常正常。临床面临的挑战是在神经功能受损之前检测并治疗脊柱疾病。脊髓造影一直是识别硬膜外转移瘤的标准检查方法，但脊髓造影的侵入性具有内在风险，会给患者带来不适。磁共振成像（MRI）在评估其他脊柱疾病方面很有用，它是非侵入性的，患者耐受性良好。我们对MRI（58例患者的64项研究）与传统检查（脊髓造影、计算机断层扫描、骨扫描、平片）进行了评估和比较，并确定了其在诊断方面的准确性以及在临床决策中的有效性。MRI在检测肿瘤对骨骼和硬膜外的侵犯方面被证明更具优势，并且在临床决策中很有价值。此外，MRI能更好地显示肿瘤对椎旁软组织的侵犯情况。对于疑似脊柱转移瘤的患者，建议将MRI作为首选检查。
