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Tests and diagnosis
By Mayo Clinic staffSpinal tumors sometimes may be overlooked because they're rare and because their symptoms resemble those of more common conditions. For that reason, it's especially important that your doctor know your complete medical history and perform both physical and neurological exams. If your doctor suspects a spinal tumor, one or more of the following tests can help confirm the diagnosis and pinpoint the tumor's location:
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Spinal magnetic resonance imaging (MRI). Instead of radiation, MRI uses a powerful magnet and radio waves to produce cross-sectional images of your spine. MRI accurately shows the spinal cord and nerves and yields better pictures of bone tumors than computerized tomography (CT) scans do. A contrast agent that makes certain tissues and structures light up may be injected into a vein in your hand or forearm during the test. In addition, some medical centers use high-field-strength scanners to find small tumors that might otherwise be missed.
You may feel claustrophobic inside the scanner or find the loud thumping sound it makes disturbing. But you're usually given earplugs to help with the noise, and some scanners are equipped with televisions or headphones. If you're very anxious, your doctor may prescribe a mild sedative.
- Computerized tomography (CT). This test uses a narrow beam of radiation to produce detailed, cross-sectional images of your spine. Sometimes it may be combined with an injected contrast dye to make abnormal changes in the spinal canal or spinal cord easier to see. Although not invasive, this test exposes you to more radiation than a regular X-ray does.
- Myelogram. In this test, a contrast dye is injected into your spinal column. The dye then circulates around your spinal cord and spinal nerves, which appear white on an X-ray or CT scan. Because the test poses more risks than does an MRI or conventional CT, a myelogram is usually not the first choice for diagnosis, but it may be used to help identify compressed nerves.
- Biopsy. The only way to determine whether a tumor is noncancerous or cancerous is to examine a small tissue sample (biopsy) under a microscope. If the tumor is cancerous, biopsy also helps determine the cancer's grade — information that helps determine treatment options. Grade 1 cancers are generally the least aggressive and grade 4 cancers, the most aggressive. How the sample is obtained depends on your overall health and the location of the tumor. Your doctor may use a fine needle to withdraw a small bit of tissue, or the sample may be obtained during an operation.
- Brain and spinal tumors: Hope through research. National Institute of Neurological Disorders and Stroke. http://www.ninds.nih.gov/disorders/brainandspinaltumors/detail_brainandspinaltumors.htm#43233060. Accessed July 25, 2009.
- Welch WC, et al. Spinal cord tumors. http://www.uptodate.com/home/index.html. Accessed July 25, 2009.
- Donthineni R. Diagnosis and staging of spine tumors. Orthopedic Clinics of North America. 2009;40:1.
- Schiff D. Clinical features and diagnosis of epidural spinal cord compression, including cauda equina syndrome. http://www.uptodate.com/home/index.html. Accessed July 25, 2009.
- Detailed guide: Brain / CNS tumors in adults. American Cancer Society. http://www.cancer.org/docroot/CRI/CRI_2_3x.asp?rnav=cridg&dt=3. Accessed July 25, 2009.
- DeAngelis LM. Tumors of the central nervous system and intracranial hypertension and hypotension. In: Goldman L, et al., eds. Cecil Medicine. 23rd ed. Philadelphia, Pa.: Saunders Elsevier; 2007. http://www.mdconsult.com/das/book/body/151491959-3/0/1492/741.html?tocnode=54620820&fromURL=741.html#4-u1.0-B978-1-4160-2805-5..50204-4--cesec51_9020. Accessed July 25, 2009.
- Cole JS, et al. Metastatic epidural spinal cord compression. Lancet Neurology. 2008;7:459.
- Moynihan TJ (expert opinion). Mayo Clinic, Rochester, Minn. Aug. 2, 2009.
