Thomas N. Byrne, MD

As outlined by Dr. Ruckdeschel,the evaluation and management of metastatic spinal metastasesand associated epidural spinalcord compression have been simplifiedby the advent of magnetic resonanceimaging (MRI), which is muchmore sensitive and specific than plainx-rays and radionuclide bone scanning.Furthermore, because most patientscan now undergo MRI ratherthan invasive myelography, thethreshold for diagnosing epiduralmetastatic disease has been lowered.Accordingly, it has become the test ofchoice for evaluating most patientswith suspected spinal metastases.