ABSTRACT
This chapter outlines the use of imaging, in particular magnetic resonance imaging (MRI) as the primary modality for the diagnosis of spinal metastases, spine stereotactic body radiotherapy (SBRT) planning, and response assessment after treatment. Spine SBRT requires strict planning guidelines to safely deliver ablative doses to tumor while minimizing risk of toxicity, specifically by limiting the dose to the nearby spinal cord or thecal sac, collectively referred to as the critical neural tissue. The SPINO guidelines defines response assessment after SBRT for spinal metastases. Similar to the phenomena observed in patients with glioma following radiotherapy, osseous pseudoprogression has been defined by SPINO as an imaging-based, transient increase in apparent tumor size following SBRT. This increase mimics disease progression; however, in pseudoprogression, the enlargement subsequently stabilizes or resolves without any further intervention.
