Clinical question: Assess for cause of severe bilateral leg pain involving calves, thighs, groin. 65-year-old female with metastatic pancreatic cancer. Signs and symptoms: As above. Pre- and post enhanced lumbar MRI:Examination demonstrates multiple osseous metastatic lesion of the thoracolumbar and sacral spine without intravenous fracture or malalignment and without evidence of epidural or paraspinal soft tissue is present. Metastatic lesions are noted in the partially visualized anterior body of and the left pars articularis of T11, large metastatic lesion involving nearly entire vertebral body of L2 and the base of the base of the spinous process, small metastatic lesion in the dorsal inferior midline body of L4, large metastatic lesion involving vertebral body of L5 and extending into the left pedicle, left articulating facet and left transverse process and a large metastatic lesion involving extensively the vertebral body of S1. The lesions demonstrate T1 hypointensity, T2 hyperintensity and with enhancement.Visualized lower thoracic cord, conus and cauda equina demonstrate no detectable abnormal enhancement to suggest metastases.Moderate degenerative changes at L4-L5 and mild bilateral facet and ligamentum flavum hypertrophy as well as bilateral facet effusion results in moderate central spinal stenosis without neural foraminal compromise.No evidence of spinal stenosis at any other level. Degenerative changes at L5-S1 however results in significant bilateral neural foraminal compromise. Partially visualized iliac wings also demonstrate a metastatic lesion on the left measuring approximately at 10 x 15 mm in transaxial dimensions.Findings on this exam were discussed with the clinical service Kwang Jin Choi # 5662 at the time of review of exam.
1.Multiple intraosseous metastatic lesions involving lower most visualized thoracic spine, lumbar spine and sacral spine as well as left iliac wing detailed above. No evidence of extraosseous spread of tumor.2.No detectable leptomeningeal enhancement.3.Extensive degenerative changes at L4-L5 results in moderate central spinal stenosis without neural foraminal compromise.4.Degenerative changes at L5-S1 results in significant bilateral neural foraminal compromise and without central spinal stenosis.5.No spinal stenosis or neural foraminal compromise at any other level.