Diagnostic Accuracy of CT for Metastatic Epidural Spinal Cord Compression

Abstract

Background: Early diagnosis of metastatic epidural spinal cord compression (MESCC) is vital to expedite therapy and prevent paralysis. Staging CT is performed routinely in cancer patients and presents an opportunity for earlier diagnosis. Methods: This retrospective study included 123 CT scans from 101 patients who underwent spine MRI within 30 days, excluding 549 CT scans from 216 patients due to CT performed post-MRI, non-contrast CT, or a gap greater than 30 days between modalities. Reference standard MESCC gradings on CT were provided in consensus via two spine radiologists (11 and 7 years of experience) analyzing the MRI scans. CT scans were labeled using the original reports and by three radiologists (3, 13, and 14 years of experience) using dedicated CT windowing. Results: For normal/none versus low/high-grade MESCC per CT scan, all radiologists demonstrated almost perfect agreement with kappa values ranging from 0.866 (95% CI 0.787–0.945) to 0.947 (95% CI 0.899–0.995), compared to slight agreement for the reports (kappa = 0.095, 95%CI −0.098–0.287). Radiologists also showed high sensitivities ranging from 91.51 (95% CI 84.49–96.04) to 98.11 (95% CI 93.35–99.77), compared to 44.34 (95% CI 34.69–54.31) for the reports. Conclusion: Dedicated radiologist review for MESCC on CT showed high interobserver agreement and sensitivity compared to the current standard of care.

Biological and Clinical Aspects of Metastatic Spinal Tumors

“…In comparison with the widespread X-ray, it is more sensitive and allows for better visualization of lesions. This diagnostic method allows us to visualize all types of metastases, both osteolytic (they have a clearer outline than on a regular X-ray image) and osteoblastic (less visible bone trabeculae, blurred border between the cortical bone and cancellous bone) [ 128 ]. CT is likely to obtain a spatial image, which allows for a more accurate determination of the extent of metastases.…”