Reason: evaluate for mets, staging of tumor History: Breast Ca MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. There are multiple marrow replacing lesions throughout the calvarium. The largest one is adjacent to the superior sagittal sinus and is associated with some mild displacement of the superior sagittal sinus inferiorly. It measures approximately 36 by 10 mm sagittal dimensions and appears to have an epidural component.No abnormal enhancing mass lesions are appreciated within the brain parenchyma. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment. The cervical spinal cord has normal signal characteristics and overall morphology. There are multiple marrow replacing lesions present throughout the cervical spine with near complete marrow replacement at C4, C5 and C6. There is mild loss of vertebral body height at C4.At C2-3 there is no significant compromise to the spinal canal or neural foramina. There are endplate osteophytes and uncovertebral osteophytes at this level appear to be old but worse on the right side versus the left where there is narrowing of the right neural foramen.At C3-4 there is loss of disk space height and endplate osteophytes with bilateral narrowing of neural foramina and partial effacement of spinal fluid ventral, but not posterior to the spinal cord. There is a an infiltrating enhancing lesion extending into the left neural foramen and encroaching on the left-sided exiting nerve root at this levelAt C4-5 there is loss of disk space height, endplate osteophytes and bilateral uncovertebral osteophytes resulting in narrowing of neural foramina - right worse than left - with partial effacement of spinal fluid ventral, but not posterior to the spinal cord. There is encroachment of right-sided exiting nerve roots and to a lesser degree left-sided exiting nerve roots at this level. There is a an infiltrating enhancing lesion extending into the left neural foramen and encroaching on the left-sided exiting nerve root at this level and displacing the left vertebral artery.At C5-6 there is loss of disk space height and endplate osteophytes with mild bilateral narrowing of neural foramina. There is no significant compromise to the spinal canal or neural foramina. There is a an infiltrating enhancing lesion extending into the left neural foramen at this level.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.Thoracic spine:The thoracic vertebral bodies are appropriate in the overall alignment. There is a compression fracture present at T12 with mild retropulsion into the spinal canal.There are multiple marrow replacing lesions throughout the thoracic spine worse at T3 through T6. There is epidural extension of tumor extending from the C3-4 to the T5-6 level and resulting in spinal stenosis at the T5 vertebral body level with effacement spinal fluid compression of the spinal cord. There is additional infiltration of the neural foramina bilaterally at the C4-5, C5-6 and C6-7 and T7-T8.There is an infiltrating lesion extending into the right neural foramina at the T11-T12 and T12-L1 levels and affecting the exiting nerve roots appear infiltrating lesions extending to the left neural foramina at T9-10.There are small bilateral pleural effusions present
1.There are multiple marrow replacing lesions scattered throughout the cervical spine and thoracic spine. 2.There is associated epidural extension of the tumor into the spinal canal from the T3-4 disk space level to the T5-6 disk space level with spinal stenosis from epidural extension at the T5 vertebral body level. There is also associated multilevel neural foramen encroachment throughout the thoracic spine as detailed above.3.There a malignant compression fracture present at T12.4.There is a combination of degenerative changes present in the cervical spine and metastatic disease in the cervical spine resulting in mild spinal stenosis at C4-5 and there is muultilevel neural foramina encroachment present due to infiltrating tumor at multiple levels as detailed above.5.There are multiple calvarial-based lesions throughout the skull one of which displaces the superior sagittal sinus. There are no brain parenchymal metastases appreciated however.6.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 7.Bilateral pleural effusions.