MRI Whole Spine — suspected metastatic cord compression
Craniocervical junction to the sacrum and coccyx in continuous sagittal stations, with axial imaging through every significant abnormality.
Typical, not policy
Timings, volumes and delays here are representative values drawn from published guidance. Scanner generation, injector, cardiac output and local preference all move them. Confirm against your department's own protocol before you rely on a number.
When to use it
- Known or suspected malignancy with new or progressive back pain and any neurological symptom or sign — the definitive same-day indication.
- Known malignancy with severe progressive spinal pain even without neurology, where impending compression would change management.
- Suspected multilevel or skip vertebral metastatic disease before radiotherapy planning.
- Unexplained new bilateral leg weakness, sensory level or sphincter disturbance in a patient with a cancer history.
Technique
- Sagittal T1 and sagittal STIR (or T1 and T2 with fat suppression) across the whole spine are the core survey: T1 detects marrow replacement, the fluid-sensitive sequence shows oedema and soft-tissue extension.
- Sagittal T2 demonstrates the level and degree of thecal sac and cord deformity.
- Axial imaging is then acquired through each significant level to define circumferential extent and canal compromise.
- Coverage must be genuinely whole-spine: multilevel disease is common and a regional study cannot exclude a second compressive level.
Where it goes wrong
- Regional imaging only, chosen because the pain is localised. Skip lesions are the entire reason whole-spine coverage exists.
- Sagittal-only study with no axial sections through the abnormality, which under-describes canal compromise and root involvement.
- STIR omitted at the busiest stations, losing sensitivity for marrow infiltration.
- Truncated superior or inferior coverage — the craniocervical junction and the sacrum are the two ends most often clipped.
- Non-diagnostic study from motion in an uncomfortable patient because analgesia was not arranged first.
Clinical questions that reach this study
Suspected multiple sclerosis or first demyelinating eventSuspected metastatic spinal cord compressionSuspected cauda equina syndromeSuspected discitis, vertebral osteomyelitis or epidural abscessLow back pain without red flagsSuspected inflammatory spinal cord lesion (transverse myelitis)Thoracic back pain and suspected thoracic myelopathyThoracolumbar spine traumaSuspected myeloma — skeletal assessmentSuspected bone metastases
Contrast
None
- The compression question is answered unenhanced. Contrast is added only where the differential includes infection, an intramedullary lesion or leptomeningeal disease.
Acquisition
- Breathing
- Free breathing. Total table time is the limiting factor in a patient in pain, so the sagittal survey is acquired first.
- Preparation
- For suspected MSCC state neurological findings and time of onset — this is a same-day pathway, not a routine list slot. Analgesia and positioning support should be arranged in advance; an incomplete study because the patient could not lie flat is a failed study. Gadolinium is not needed to answer the compression question and is added only for infection, inflammation or when a soft-tissue mass needs characterising.
Safety checks this protocol carries
Derived from the contrast agent and phases above, not authored here — which is why they cannot drift apart from what the protocol actually does.
- MR safety screening for implants and foreign bodies· radiographer at scan