Female, 73 years old, with stage IV lung cancer and ongoing upper back pain. Mild compression of the T1 vertebral body is seen with approximately 20% loss of vertebral body height. Mild edema is seen along the superior endplate more than the inferior endplate with edema also evident in the left T1 pedicle and lamina. On postcontrast images, enhancement is seen in a pattern similar to that of the edema.The anterior paravertebral soft tissues around the T1 level are thickened and edematous. Particularly on the left, there is a well defined area of soft tissue thickening which measures 12 x 12 mm transaxial and up to 33 mm in the craniocaudal dimension.The remaining vertebral bodies demonstrate relative preservation of height allowing for endplate irregularity throughout the cervical region. Spinal alignment is anatomic. No other pathologic marrow signal or enhancement is seen.The spinal cord demonstrates normal signal intensity throughout. Details of cord morphology will be discussed by level below.C2-3: Mild facet hypertrophy. Minimal disk osteophyte complex. No significant spinal canal or neuroforaminal stenosis. C3-4: Facet hypertrophy. Posterior disk osteophyte. Mild generalized spinal canal stenosis with mild flattening of the ventral cord. No cord signal abnormality. Mild left foraminal narrowing.C4-5: Facet hypertrophy. Mild posterior disk osteophyte. Mild generalized spinal canal stenosis without definite cord deformation. Moderate right and mild left foraminal narrowing. C5-6: Facet hypertrophy. Posterior disk osteophyte asymmetric to the left. Mild generalized spinal canal narrowing without definite cord deformation. Severe left and moderate right foraminal narrowing.C6-7: Facet hypertrophy. Mild posterior disk osteophyte. Mild generalized spinal canal stenosis. Moderate bilateral foraminal narrowing. C7-T1: Facet hypertrophy worse on the left. No significant spinal canal stenosis. Moderate left foraminal narrowing.Multiple pulmonary nodules are visualized in the lung apices.
A mild compression deformity of the T1 vertebral body is seen with associated edema and enhancement. Also noted is inflammation in the anterior paravertebral soft tissues adjacent to T1 with a more mass-like soft tissue lesion on the left. The constellation of findings is suspicious for metastatic involvement of the T1 vertebral body and possibly the adjacent anterior paravertebral tissues. A benign process is considered much less likely.