Follow-Up Recommendations Vary Widely for Indeterminate T1-Hypointense Vertebral Lesions on Spine MRI

In a retrospective review of 259 indeterminate T1-hypointense vertebral lesions on spine MRI, 77% of reports recommended further imaging, but only 49% specified timing; recommended intervals ranged from 2-4 weeks to 6-12 months, and modality recommendations were inconsistent.

• 53% of reports recommended follow-up MRI, 16% CT, 9% nuclear imaging, and 8% unspecified modality.
• Only 17 cases with initial non-contrast MRI had repeat contrast-enhanced study within 30 days; all three malignant lesions found were in patients with known or concurrent metastatic disease.
• Malignancy history did not strongly influence the chance of a follow-up recommendation, but follow-up timing was sooner with known malignancy (mean 2.9-3.4 months) versus no cancer (5 months).

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