Intramedullary Spinal Cord Metastases: Prognostic Value of MRI and Clinical Features from a 13-Year Institutional Case Series

The presence of multiple ISCMs was a poor prognostic indicator. A 76-year-old man with metastatic non-small cell lung cancer. Lung or breast carcinoma was a poor prognostic feature compared with all other primary malignancy types. MR images of the cervical and lumbar spine with postcontrast fat-saturated sagittal (A, D, and E) and axial (B) T1-weighted and axial T2-weighted (C) images are shown. ISCMs are present at C2 (arrows, A and B) and L1 (arrows, C and D). Compared with solitary ISCMs, multiple ISCMs were associated with decreased survival. This patient survived 59 days from the diagnosis of ISCMs. The median survival of patients with multiple ISCMs was 53 days, compared with 121 days for those with a solitary ISCM. The conus lesion demonstrates the flame sign¹ inferiorly (arrowhead, D); the presence of this sign was associated with a non-statistically significant trend toward shorter survival. Note that multiple enhancing noncord CNS and spinal (osseous) metastases are present, including in the cerebellum (E); their presence did not correlate with a shorter survival.

The presence of extensive edema was a poor prognostic indicator. A 55-year-old man with metastatic cerebral glioblastoma. MR images of the thoracic spine with sagittal T2- (A) and postcontrast T1-weighted sagittal (B) and axial (C) images are shown. An ISCM is present at T4 (arrows, A–C). Extensive edema for lesion size spans 5 vertebral segments, from the T1–T2 to T6–T7 levels (arrowheads, A). Spinal cord edema spanning multiple segments was associated with decreased survival in this series. This patient survived 19 days from the diagnosis of ISCMs. The median survival of patients with cord edema spanning ≥3 segments was 111 days, compared with 184 days for patients in whom it spanned ≤2 (note that the T7 vertebral body lesion is an incidental hemangioma).

The ancillary presence of primary malignancy and/or non-CNS metastases on reference MR imaging was a poor prognostic indicator. A 39-year-old man with metastatic non-small cell lung cancer. MR images of the cervical, thoracic, and lumbar spine with sagittal T2- (A), postcontrast T1-weighted (B), fat-saturated T1-weighted (C), and axial T2-weighted (D) images, and an axial postcontrast chest CT image (E) are shown. An ISCM is present at C3 (arrows, A and B). The primary lung carcinoma is visualized in the right upper lobe (arrowheads, D and E), as are several presumed pulmonary metastases (eg, arrows, D and E). The presence of the primary malignancy and/or non-CNS metastases was associated with decreased survival in this series. This patient survived 24 days from the diagnosis of ISCM. The median survival of patients with visible primary malignancy/non-CNS metastases was 96 days, compared with 316 days for patients in whom these were not visible. Note that leptomeningeal metastases are present (block arrows, B and C); their presence did not correlate with a shorter survival.