Clinical question: Rule out cord compression; known lung cancer. Signs and symptoms: As above. Pre-and post enhanced lumbar MRI:The field of exam spans from the T10 through S3 levels. External there are multiple foci of marrow signal changes with subtle varying degree of enhancement and consistent with multiple foci of osseous metastatic disease. These findings were all present on prior CT of chest from February 11.There is no evidence of the spinal canal compromise or stenosis from T10 through L2 levels and without evidence of cord /conus/cauda equina compression.Metastatic T11 vertebrae demonstrate less than 50% compression deformity and mild expansion into the spinal canal however without central spinal stenosis.No evidence of any additional vertebral body fracture. There is no evidence of extension of metastatic lesion into the epidural space or the paraspinal soft tissues at any level.At L2 -- L3 there is a broad based central and rightward shadow disk protrusion with subtle mass effect on the thecal sac and mild central spinal stenosis.Extensive degenerative changes and L3 -- L4 however results in moderate central spinal stenosis and right neural foraminal compromise. Extensive degenerative changes at L4 -- L5 and including mild grade 1 anterolisthesis also results in significant central spinal stenosis and moderate left neural foraminal compromise.The signal intensity and caliber are normal as visualized thoracic cord, conus and cauda equina is within normal and without detectable abnormal enhancement.
1.Multiple osseous metastatic lesions involving multiple vertebral bodies from T10 through S2 as detailed with subtle varying degree of enhancement.2.Less than 50% compression fracture of metastatic T11 vertebrae with mild expansion into the spinal canal however without spinal compromise.3.There is no evidence of stapedial spread of tumor at any level and no evidence of spinal canal compromise secondary to metastatic disease.4.Degenerative changes at L3 -- L4 and L4 -- L5 levels results in moderate to severe central spinal stenosis at these levels. 5.No evidence of signal abnormality or enhancement of the lower most visualized thoracic cord, conus or the cauda equina.