Abstract：
BACKGROUND: Spinal metastases can cause intractable pain and neurological deficits, which can markedly worsen both patients\' activities of daily living (ADL) and their health-related quality of life (QOL). Early intervention is essential to prevent irreversible neurological deficits and pain associated with spinal metastases. We investigated the imaging features of spinal metastases that led to neurological deficits.
METHODS: We analyzed axial cross-sectional computed tomography (CT) images of cervical and thoracic spinal metastases in patients with and without lower limb motor paralysis, neuropathic pain, and local nociceptive pain. We distinguished regions of the spine associated with these respective symptoms, and explored their inferable performance using images obtained before symptom onset. In addition, we analyzed the imaging features and type of bone metastasis (osteolytic and osteoblastic).
RESULTS: Spinal lesions occupied the area in and around the spinal canal and around the pedicle in patients with motor paralysis. Lesions around the pedicle and in the most posterior vertebral body part before symptom onset were inferable. In patients with neuropathic pain, spinal metastases spread along the pedicle before symptom onset, and had surrounded the spinal canal circumferentially at symptom onset. Local nociceptive pain was more common near the center of the vertebral body either at or before symptom onset. There was no difference in the imaging features according to the type of bone metastasis.
CONCLUSIONS: Lesions in certain regions in the asymptomatic metastatic spine can indicate the onset of spinal metastasis-related symptoms in the next few months. Early therapeutic intervention might be applied to prevent neurological disorder.
METHODS: We analyzed axial cross-sectional computed tomography (CT) images of cervical and thoracic spinal metastases in patients with and without lower limb motor paralysis, neuropathic pain, and local nociceptive pain. We distinguished regions of the spine associated with these respective symptoms, and explored their inferable performance using images obtained before symptom onset. In addition, we analyzed the imaging features and type of bone metastasis (osteolytic and osteoblastic).
RESULTS: Spinal lesions occupied the area in and around the spinal canal and around the pedicle in patients with motor paralysis. Lesions around the pedicle and in the most posterior vertebral body part before symptom onset were inferable. In patients with neuropathic pain, spinal metastases spread along the pedicle before symptom onset, and had surrounded the spinal canal circumferentially at symptom onset. Local nociceptive pain was more common near the center of the vertebral body either at or before symptom onset. There was no difference in the imaging features according to the type of bone metastasis.
CONCLUSIONS: Lesions in certain regions in the asymptomatic metastatic spine can indicate the onset of spinal metastasis-related symptoms in the next few months. Early therapeutic intervention might be applied to prevent neurological disorder.
摘要：
背景：脊柱转移可引起顽固性疼痛和神经功能缺损，这会显著恶化患者的日常生活活动(ADL)和他们的健康相关生活质量(QOL)。早期干预对于预防不可逆的神经功能缺损和与脊柱转移相关的疼痛至关重要。我们调查了导致神经功能缺损的脊柱转移瘤的影像学特征。
方法：我们分析了有和没有下肢运动麻痹的患者的颈椎和胸椎转移瘤的轴向横截面计算机断层扫描（CT）图像，神经性疼痛,和局部的伤害性疼痛。我们区分了与这些症状相关的脊柱区域，并使用症状发作前获得的图像探索它们的可推断性能。此外,我们分析了骨转移的影像学特征和类型（溶骨和成骨细胞）。
结果：在运动麻痹患者中，脊柱病变占据了椎管内和椎弓根周围的区域。在症状发作之前，椎弓根周围和椎体最后部的病变是可推断的。在神经性疼痛患者中，脊柱转移灶在症状发作前沿着椎弓根扩散，并在症状发作时周向环绕椎管。在症状发作时或之前，椎体中心附近的局部伤害性疼痛更为常见。根据骨转移的类型，影像学特征没有差异。
结论：无症状转移性脊柱某些区域的病变可能表明脊柱转移相关症状在未来几个月内出现。早期治疗干预可用于预防神经系统疾病。
方法：我们分析了有和没有下肢运动麻痹的患者的颈椎和胸椎转移瘤的轴向横截面计算机断层扫描（CT）图像，神经性疼痛,和局部的伤害性疼痛。我们区分了与这些症状相关的脊柱区域，并使用症状发作前获得的图像探索它们的可推断性能。此外,我们分析了骨转移的影像学特征和类型（溶骨和成骨细胞）。
结果：在运动麻痹患者中，脊柱病变占据了椎管内和椎弓根周围的区域。在症状发作之前，椎弓根周围和椎体最后部的病变是可推断的。在神经性疼痛患者中，脊柱转移灶在症状发作前沿着椎弓根扩散，并在症状发作时周向环绕椎管。在症状发作时或之前，椎体中心附近的局部伤害性疼痛更为常见。根据骨转移的类型，影像学特征没有差异。
结论：无症状转移性脊柱某些区域的病变可能表明脊柱转移相关症状在未来几个月内出现。早期治疗干预可用于预防神经系统疾病。
