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Updated: Nov 7, 2025
Diffusion Tensor Magnetic Resonance Imaging in Chronic Spinal Cord Compression
Published on: May 7, 2019
Can MRI be used as a safe and expedient option for calculating Spinal Instability Neoplastic Score for patients with
Patrick Hurley1, Christine Azzopardi2, Rajesh Botchu2
1University of Birmingham Medical School, Birmingham, UK.
Aims:
The aim of this study was to assess the reliability of using MRI scans to calculate the Spinal Instability Neoplastic Score (SINS) in patients with metastatic spinal cord compression (MSCC).
Methods:
A total of 100 patients were retrospectively included in the study. The SINS score was calculated from each patient's MRI and CT scans by two consultant musculoskeletal radiologists (reviewers 1 and 2) and one consultant spinal surgeon (reviewer 3). In order to avoid potential bias in the assessment, MRI scans were reviewed first. Bland-Altman analysis was used to identify the limits of agreement between the SINS scores from the MRI and CT scans for the three reviewers.
Results:
The limit of agreement between the SINS score from the MRI and CT scans for the reviewers was -0.11 for reviewer 1 (95% CI 0.82 to -1.04), -0.12 for reviewer 2 (95% CI 1.24 to -1.48), and -0.37 for reviewer 3 (95% CI 2.35 to -3.09). The use of MRI tended to increase the score when compared with that using the CT scan. No patient having their score calculated from MRI scans would have been classified as stable rather than intermediate or unstable when calculated from CT scans, potentially leading to suboptimal care.
Conclusion:
We found that MRI scans can be used to calculate the SINS score reliably, compared with the score from CT scans. The main difference between the scores derived from MRI and CT was in defining the type of bony lesion. This could be made easier by knowing the site of the primary tumour when calculating the score, or by using inverted T1-volumetric interpolated breath-hold examination MRI to assess the bone more reliably, similar to using CT. Cite this article: Bone Joint J 2021;103-B(5):971-975.
Insights
Magnetic resonance imaging (MRI) reliably calculates the Spinal Instability Neoplastic Score (SINS) for metastatic spinal cord compression (MSCC), though bony lesion assessment may differ from CT scans. This score is crucial for guiding treatment decisions in MSCC patients.
Area of Science:
- Orthopedics
- Radiology
- Oncology
Background:
- Metastatic spinal cord compression (MSCC) requires accurate assessment of spinal instability.
- The Spinal Instability Neoplastic Score (SINS) is a tool used to evaluate instability in MSCC.
- Reliability of Magnetic Resonance Imaging (MRI) for SINS calculation is under investigation.
Purpose of the Study:
- To evaluate the reliability of MRI scans in calculating the SINS score for patients with MSCC.
- To compare SINS scores derived from MRI with those from Computed Tomography (CT) scans.
Main Methods:
- Retrospective study of 100 MSCC patients.
- SINS scores calculated from MRI and CT scans by three expert reviewers.
- Bland-Altman analysis to assess agreement between MRI and CT derived SINS scores.
Main Results:
- MRI demonstrated reliable SINS score calculation compared to CT.
- A tendency for MRI to yield higher scores than CT was observed.
- Differences in bony lesion characterization between MRI and CT were noted, potentially impacting classification.
Conclusions:
- MRI is a reliable tool for SINS score calculation in MSCC.
- Understanding primary tumor site or using specific MRI sequences can enhance bony lesion assessment.
- Accurate SINS scoring is vital for appropriate management of MSCC.
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