History of low back pain and hip flexor weakness. Known metastatic cervical cancer, including lumbar mets from CT. Evaluate spinal and nerve root involvement. Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. Within the anterior and lateral portion of the right L2 vertebral body is an enhancing lesion extending into the adjacent right soft tissues with mass effect on and deviation of the right psoas muscle compatible with an osseous metastasis with soft tissue extension. There is thickening and enhancement right L2 nerve root compatible with perineural extension of the tumor towards the epidural space but there is no evidence of leptomeningeal involvement. Similarly within the anterior and lateral portion of the right L3 vertebral body is a osseous metastatic lesion with extension into the anterior and lateral right retroperitoneum. The right L3 nerve root is thickened and enhances indicating perineural extension of tumor towards the epidural space but there is no evidence of leptomeningeal involvement. There appears to be no involvement of the pedicles. There is no loss of vertebral body height and there is no neuroforaminal or spinal canal stenosis.There is high T2/STIR signal intensity involving the adjacent right paraspinal musculature with faint diffuse enhancement but there is no necrosis or evidence of a mass. These changes could be related to post radiation inflammatory changes if the patient has had recent radiation. Less likely is diffuse infiltration of tumor.Note is made of partially visualized liver lesions compatible with the patient's known metastases. There are also multiple retroperitoneal lymph nodes partially visualized which are better evaluated on the recent prior CT of the abdomen and pelvis.
1.Osseous metastatic lesions involving the anterolateral right L2 and L3 vertebral bodies with retroperitoneal soft tissue extension of tumor and findings compatible with likely perineural spread of tumor along the right L3 and L2 nerve roots. There does not appear to be epidural or leptomeningeal involvement, or neuroforaminal or spinal canal stenosis.2.High T2/STIR signal intensity and diffuse subtle enhancement of the right posterior paraspinal soft tissues which could indicate post radiation inflammation if the patient has received recent radiation treatment. Less likely is diffuse infiltration of tumor.3.Multiple liver lesions and retroperitoneal lymph nodes are partially visualized and better characterized on the recent previous abdominal pelvic CT.