Oncological Emergencies Dr. Gary Harding md, frcpc

Clinical examination is not reliable in determining level of lesion

Entire imaging of spine is ideal

• Entire imaging of spine is ideal

• Focused CT imaging can miss clinically unapparent lesions

• Myelography and MRI are better than plain X-Rays, bone scans and CT for diagnosis

Plain Spine Radiographs

• Easiest and cheapest

• Need large bony destruction or vertebral collapse to be diagnostic

• High false negative rate

• Not recommended to confirm diagnosis

MRI vs. CT Myelography

Both image thecal sac and display indentation and encircling

• Both image thecal sac and display indentation and encircling

• CT myelography involves a lumbar puncture

• Contraindicated in brain metastases, thrombocytopenia, or coagulopathy
• Can diagnose leptomeningeal metastases
• Available in Winnipeg in middle of the night

MRI

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