Clinical question: C2 lesion, colon cancer with metastases to spine. 6 months follow-up. Signs and symptoms: Evaluate for change, six-month follow-up. Pre- and post enhanced cervical MRI:Examination demonstrates uniform T1 hyperintense, T2 hyperintense and T2 STIR hyperintense vertebral bodies and the posterior elements of C1, C2 and C3 representing prior radiation change and without evidence of enhancement or interval change.There is revisualization of multiple foci of intraosseous enhancement in the vertebral bodies of C4, C5, C6, C7, T1, T2 and its posterior elements, posterior elements of T3 and posterior body of T4 on consistent with metastatic lesions. There is no extraosseous spread of tumor. There is minimal interval increase size of metastatic lesion in the vertebral body of C4 since prior exam measuring 11 mm in length compared to 9 mm on prior study (sagittal postcontrast enhanced series). No significant change in the size of the large C5 vertebral body metastatic lesion. There is interval size of metastatic lesion in dorsal aspect of the body of C6 vertebrae measuring approximately 11 mm in height compared to prior study measurement of 5 mm. Minimal increased size of metastatic lesion in the dorsal body of C7 measuring approximately 6 mm on current exam. Previously noted metastatic lesion in the posterior element of T3 also demonstrate interval noticeable increased size measuring at 16.5 mm in cranial cephalad axis compared to prior study measurement of 6 mm.Degenerative changes and resultant moderate central spinal stenosis at C3-C4 and with resultant focal myelomalacia remains stable since prior exam. There is no detectable enhancement of the cord or the leptomeninges.
1.Stable post radiation changes of C1, C2 and C3 without evidence of metastasis.2.Extensive additional metastatic lesions involving vertebral bodies and posterior elements from C4 through T2 which most demonstrate interval increased size as detailed/measured above.3.No detectable epidural spread of tumor. No abnormal meningeal enhancement.4.Moderate Central spinal stenosis at C3-C4 and associated cord myelopathy without change since prior exam. Degenerative changes at C7-T1 also results in mild central spinal stenosis which has remained stable since prior exam.