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Diffusion Tensor Magnetic Resonance Imaging in Chronic Spinal Cord Compression
Published on: May 7, 2019
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Metastatic epidural spinal cord compression approached by MRI: could it predict neurological peril?
Quentin Beaufort1, Valentin Lefevre1, Jean-Philippe Cottier1
1Department of Neuroradiology, Hospital Bretonneau, Tours, France.
Summary
Spine metastases (SpMs) can cause debilitating neurological damage. New markers like SINS, thoracic location, and VESJA can predict neurological prognosis in metastatic epidural spinal cord compression (MESCC).
Area of Science:
- Oncology
- Neurosurgery
- Radiology
Background:
- Metastatic epidural spinal cord compression (MESCC) is a severe complication of spine metastases (SpMs), often leading to significant neurological deficits.
- Currently, reliable markers to predict neurological impairment in these patients are lacking.
Purpose of the Study:
- To identify reliable prognostic markers for neurological function in patients with MESCC.
- To compare oncological and radiological characteristics between ambulatory and non-ambulatory MESCC patients.
Main Methods:
- A prospective cohort study included 164 consecutive MESCC patients (January 2014-2021).
- Patients were categorized into ambulatory (Frankel D-E) and non-ambulatory (Frankel A-C) groups.
- Oncological and radiological features were compared; multivariate analysis identified independent prognostic factors.
Main Results:
- The ambulatory group had significantly longer overall survival (15.6 months) than the non-ambulatory group (5.8 months).
- Thoracic MESCC, a vertical epiduritis-spine junction angle (VESJA) <150°, and Spinal Intervention Prognostic Score (SINS) <7 were independently associated with neurological prognosis.
- VESJA demonstrated high interrater reliability (ICC: 0.83, κ: 0.85).
Conclusions:
- SINS <7, thoracic MESCC, and VESJA are independent predictors of neurological prognosis in MESCC.
- These markers can aid neurosurgeons in surgical decision-making for MESCC patients.
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