Although primary tumors of the spine are uncommon [83], an estimated 10% of cancer patients develop symptomatic spinal metastases during the course of their disease [84], making the spine the most common site of osseous metastatic disease [85]. Suspected spinal metastases are typically diagnosed using cross-sectional imaging with the dual goal of identifying potential metastases and characterizing the extent of malignancy. As such, the choice of imaging modality is often based on both the type of malignancy and the presenting clinical features, especially if referable to pathological fracture, cord compression, or nerve root impingement. CT Cervical Spine Because of its high spatial resolution, CT is more sensitive than conventional radiography for the detection of bone metastases and has shown good correlation with nuclear bone scans, particularly if coupled with concurrent CT examinations of the thorax, abdomen, and/or pelvis [86]. CT can help characterize lesions as lytic or blastic and may successfully assess paravertebral or intraspinal extension if intravenous contrast is used [87]. CT is also useful to obtain better structural definition of abnormal findings identified on scintigraphy or MRI [88], such as in the setting of suspected pathologic fracture. However, given that CT is relatively insensitive for tumors restricted to the marrow space, the sensitivity of CT is relatively low in early malignant bone involvement [87,89], and as such, MRI is favored as an initial diagnostic modality. CT Myelography Cervical Spine The literature search did not identify any studies regarding the use of CT myelography in the evaluation of this clinical presentation. CTA Neck The literature search did not identify any studies regarding the use of CTA in the evaluation of this clinical presentation.
Cervical Neck Pain or Cervical Radiculopathy PCAs. Although primary tumors of the spine are uncommon [83], an estimated 10% of cancer patients develop symptomatic spinal metastases during the course of their disease [84], making the spine the most common site of osseous metastatic disease [85]. Suspected spinal metastases are typically diagnosed using cross-sectional imaging with the dual goal of identifying potential metastases and characterizing the extent of malignancy. As such, the choice of imaging modality is often based on both the type of malignancy and the presenting clinical features, especially if referable to pathological fracture, cord compression, or nerve root impingement. CT Cervical Spine Because of its high spatial resolution, CT is more sensitive than conventional radiography for the detection of bone metastases and has shown good correlation with nuclear bone scans, particularly if coupled with concurrent CT examinations of the thorax, abdomen, and/or pelvis [86]. CT can help characterize lesions as lytic or blastic and may successfully assess paravertebral or intraspinal extension if intravenous contrast is used [87]. CT is also useful to obtain better structural definition of abnormal findings identified on scintigraphy or MRI [88], such as in the setting of suspected pathologic fracture. However, given that CT is relatively insensitive for tumors restricted to the marrow space, the sensitivity of CT is relatively low in early malignant bone involvement [87,89], and as such, MRI is favored as an initial diagnostic modality. CT Myelography Cervical Spine The literature search did not identify any studies regarding the use of CT myelography in the evaluation of this clinical presentation. CTA Neck The literature search did not identify any studies regarding the use of CTA in the evaluation of this clinical presentation.