MRI in Metastatic Spine Disease

5–10% of cancer patients develop spinal metastases during the course of their disease. With spinal metastases, a T1-weight MRI will show a decrease in the normal hyperintensity signal of the vertebra. This will present with a hypointense vertebrae with the disc appearing brighter than the bone. On a T2-weight MRI, you will see an increase in the normal hypointense signal of the vertebrae, with the vertebrae instead becoming hyperintense. MRI is an important imaging modality in spinal pathology due to its high spatial resolution bone marrow visualization. With T1-weighted imaging, we are able to evaluate vertebral body bone marrow replacement, and with T2-weighted imaging we can evaluate for soft-tissue extension and bone destruction. MRI of the spine can answer three important diagnostic questions in metastasis: is there a lesion, what is the level of involvement, and is there cord compression?