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 NICE NG234. 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 NICE NG234. An overnight MRI may be offered if an urgent diagnosis is needed to enable immediate treatment NICE NG234.

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 NICE NG234. 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 NICE NG234. Supplementary axial imaging should be performed through any significant abnormality noted on the sagittal scan NICE NG234.

If MRI is contraindicated, a CT scan should be carried out for people with suspected spinal metastases or MSCC NICE NG234. Rarely, if more information is needed, myelography can be performed after CT scanning, but only at a neuroscience or spinal surgical centre NICE NG234. It is important not to perform plain X-rays of the spine to diagnose or rule out spinal metastases or MSCC NICE NG234. Radiological imaging should be overseen by a radiologist to ensure appropriate and complete imaging is performed and results are reported urgently NICE NG234.