Clinical question: Evaluate for metastases, history of prostate cancer. Signs and symptoms: Bilateral lower extremity weakness. Pre- and post enhanced cervical MRI:Examination demonstrates a large focus of marrow signal replacement with enhancement involving vertebral body of C6 and with involvement of left pedicle and left articulating facet with enhancement. Finding is consistent with a metastatic lesion. There is no detectable extraosseous spread of tumor into the spinal canal. There is no convincing evidence of any additional osseous metastatic lesions of the cervical spine and no detectable metastatic lesion to the cord or the leptomeninges.Degenerative changes at C4-C5 and to a lesser degree at C3-C4 and C5-C6 results in central spinal stenosis. Significant bilateral neural foraminal compromise at C4-C5, C5-C6 secondary to degenerative changes are noted. Mild neural foraminal compromise at other levels.Pre and post enhanced thoracic MRI:Examination demonstrates extensive osseous metastatic lesions involving T2, T3, T4, T5, T6, T7, T8, T10, T11 and T12 vertebral bodies and some with involvement of posterior elements. No evidence of fracture or malalignment.There is evidence of tumor also in the epidural space posteriorly at T3, T4 and to a lesser degree T5 levels with resultant mass effect and flattening deformity of the cord and central spinal stenosis at C3 and C4 level. Although difficult to assess due to flattening deformity there is no convincing evidence of cord edema on this study, however this possibility cannot be entirely excluded. There is no evidence of central spinal stenosis or appreciable mass effect on the cord at any other level.There is normal signal intensity and caliber of thoracic cord otherwise and without detectable enhancement of the cord or the meninges.Pre and post enhanced lumbar MRI:Examination demonstrates diffuse osseous metastatic lesions of the vertebral column however without evidence of malalignment. Fracture of L4 vertebral body is again noted as well as seen on prior CT of the abdomen from 4-7-15.There is no detectable extraosseous spread of tumor into the spinal canal.There is normal signal intensity of the lower most visualized thoracic cord, conus and cauda equina without abnormal enhancement.Degenerative changes at L4-L5 and including a small central disc protrusion results in significant central spinal stenosis and moderate bilateral neural foraminal compromise. Degenerative changes at L3-L4 also result in moderate central spinal stenosis and moderate right neural foraminal compromise. Degenerative changes at L2-L3 results in mild central spinal stenosis and without neural foraminal compromise.
1.Pre and post enhanced MRI of cervical spine demonstrate metastatic lesion involving the vertebral body of C6, left pedicle and articulating facets with enhancement. No detectable extraosseous spread of tumor. Moderate central spinal stenosis at C4-C5 and to a lesser degree at C3-C4 and C5-C6 levels and significant bilateral neural foraminal compromise C4-C5 and C5-C6 levels secondary to degenerative changes are noted. No detectable but the meningeal enhancement.2.Pre and post enhanced MRI of thoracic spine demonstrate diffuse osseous metastatic lesions involving vertebral bodies and to a lesser degree of the posterior elements. There is also evidence of metastatic lesion in the dorsal epidural space at T3-T5 levels and with evidence of mass effect, flattening deformity and central spinal stenosis which is most noticeable at T3 and T4 levels. No fracture or malalignment and normal signal intensity of the cord without enhancement.3.Pre- and post enhanced lumbar MRI demonstrates diffuse intraosseous metastatic lesions. Fracture of metastatic L4 vertebral body without significant change since prior CT of abdomen. No evidence of leptomeningeal metastatic lesions. Significant central spinal stenosis secondary to degenerative disease at L4-L5 and moderate central spinal stenosis at L3-L4 as detailed above. Multilevel neural foraminal compromise as mentioned in the body of report.