Imaging of Epidural Spinal Cord Compression

Epidural spinal cord compression is an ominous complication of metastatic disease, which can result in significant neurological sequela if it is not diagnosed urgently. The patient's neurologic status should prompt imaging evaluation and, although all the imaging modalities may detect epidural spinal cord compression to some degree, magnetic resonance imaging (MRI) is the most sensitive study. Various sequences have proven useful in detection of epidural metastasis. Advanced MRI, such as diffusion tensor imaging and functional MRI, may provide functional information about the status of the spinal tract fibers, though it is still not ready for clinical use. Though imaging can be helpful in distinguishing between various epidural processes, the radiologic differential diagnosis of more difficult cases can be narrowed only by critical clinical history or biopsy.