Journal of Clinical Oncology, Vol 6, 154-157, Copyright © 1988 by American Society of Clinical Oncology
Clinical usefulness of an algorithm for the early diagnosis of spinal metastatic disease
J Redmond 3d, KE Friedl, P Cornett, M Stone, T O'Rourke and CB George
Madigan Army Medical Center, Tacoma, WA.
We have previously reported an algorithm that invokes several imaging
modalities in the early detection of metastatic and benign disease of the
spine in patients with cancer (J Clin Oncol 4:576, 1986). The development
of new lesions (shown by Tc99m bone scans) in cancer patients with normal
neurological examinations is further evaluated with plain radiographs,
spinal computed tomography (CT), and CT myelography (CT-M). Of 60 patients
in the original study, 28% were diagnosed as having only benign disease and
the remainder had spinal metastases. Thecal sac impingement was seen in 47%
of patients with metastatic disease and disruption of the posterior
vertebral cortex was noted in all patients with epidural compression. We
now report the 2- year follow-up of 55 of these patients. Without
treatment, the 17 patients diagnosed with benign disease have shown no
evidence of local failure in the spine and median survival is greater than
27 months. Thirty-eight patients diagnosed with spinal metastases had a
median survival time of 16.9 months. Radiation therapy directed by CT-M
findings provided pain relief in 78% of patients with back pain and
metastatic disease. No patient, including 19 with thecal sac impingement,
developed clinical myelopathy. These results demonstrate the usefulness of
an imaging algorithm for the early identification and distinction of spinal
metastatic disease and benign disease in patients with cancer.
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