Metastatic disease of the spine

Metastases of the spine occur in the spinal cord, dura extramedullary, epidural space, and vertebral bodies. Imaging modalities can be used to evaluate patient symptoms, screen and detect lesions, assess localization and the compartments involved (extradural, epidural, subdural, and paraspinal), and suggest therapeutic strategies. The suggested flow chart for metastases is (1) in asymptomatic patients suspected for metastases and (2) in the patient with neurological symptoms. Imaging modalities are indispensable in differential diagnosis because some nontumoral lesions can mimic metastases.