Neuroimaging for Spine Metastasis

Spine is the third most common location of metastases in the body. Spinal metastases predispose the patient to pathologic spinal fractures that have high morbidity and mortality. Diagnosing and treating spinal metastases have significant implications for the patient’s well-being. However, accurate characterization requires overcoming three major challenges: separating nonmalignant processes from metastases, separating pathologic from osteoporotic fractures, and separating posttreatment change from residual metastasis. We discuss the latest imaging advancements to help diagnose spinal metastases, separate pathologic fractures from osteoporotic fractures, and assess posttreatment spine for residual neoplasm. We discuss effective utilization of computed tomography versus conventional magnetic resonance (MR), as well as more advanced MR techniques, including diffusion-weighted imaging (DWI), perfusion MR, opposed-phase MR, and Dixon technique.