How should I prioritize imaging studies for a patient suspected of having MSCC, and what is the recommended timeframe for obtaining these images?

For a patient suspected of having spinal cord compression due to malignancy (MSCC), the highest priority imaging study is an MRI scan ¹. This should be performed as soon as possible, and always within 24 hours, at a local hospital or appropriate centre with direct access to imaging facilities ¹. An overnight MRI may be offered if an urgent diagnosis is needed to enable immediate treatment ¹.

The MRI of the spine should include sagittal T1 and/or short TI inversion recovery (STIR) sequences of the whole spine to identify spinal metastases ¹. Sagittal T2-weighted sequences are needed to show the level and degree of compression of the cord or cauda equina by a soft tissue mass and to assess possible MSCC ¹. Supplementary axial imaging should be performed through any significant abnormality noted on the sagittal scan ¹.

If MRI is contraindicated, a CT scan should be carried out for people with suspected spinal metastases or MSCC ¹. Rarely, if more information is needed, myelography can be performed after CT scanning, but only at a neuroscience or spinal surgical centre ¹. It is important not to perform plain X-rays of the spine to diagnose or rule out spinal metastases or MSCC ¹. Radiological imaging should be overseen by a radiologist to ensure appropriate and complete imaging is performed and results are reported urgently ¹.