Clinical question: Call is headache numbness in all. Signs and symptoms: Headache. Pre-and post-enhanced brain MRI:No diffusion weighted abnormalities.Examination demonstrates normal anatomical development of brain and right normal signal intensity on all MRI sequences.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and myelination of brain. This signal void of major intracranial arterial branches are identified and unremarkable. Post-enhanced images demonstrate no detectable abnormal parenchymal or leptomeningeal enhancement.Unremarkable images through the orbits and including axial fat sat post enhanced series. Images through the calvarium demonstrate multiple foci of marrow signal replacement with diffuse enhancement and highly suspected of metastatic disease. None of the lesions demonstrate extension of enhancement beyond the calvarium into the epidural space or into the soft tissues of the scalp.Pre-and post enhanced complete spine MRI:Examination of the cervical spine demonstrate normal anatomical alignment of the vertebral column.There is uniform diffuse marrow signal changes of vertebral bodies of C2, C3 with mild diffuse enhancement. There is no detectable fixation enhancement beyond the vertebral bodies into the epidural space or the perivertebral soft tissues. This findings also are similar in signal and pattern of enhancement to the findings of the calvarium and suggesting metastatic disease.There is normal signal intensity and caliber of the cervical cord without abnormal enhancement.There is mild degenerative changes of cervical spine however without evidence of spinal stenosis or clinically significant neural foraminal compromise.The perispinal soft tissues also remain within normal and without abnormal enhancement.Examination of thoracic spine also demonstrate normal anatomical alignment the vertebral column.There are uniform marrow signal replacement involving vertebral bodies of T1 and T2 with evidence of involvement of the posterior elements of both levels (worse at T11). This finding demonstrate uniform diffuse enhancement and suggestive of metastatic disease. There is minimal extraosseous spread of enhancement from the spinous process of T1.Normal signal intensity of the rest of the vertebral column and without abnormal enhancement.Normal signal intensity and caliber of thoracic cord without abnormal enhancement.No spinal stenosis or neuroforaminal compromise at any level.Examination of lumbosacral spine also demonstrate diffuse marrow signal and replacement with enhancement of the L1 vertebrae without extraosseous spread of enhancement.Patchy foci of matter signal replacement with enhancement is also present in the vertebral body of L2, L3, 5 and S3 as well as the spinous process of L3. There is mild compression deformity of the superior endplate of L1.There is normal signal intensity and morphology of cauda equina without abnormal enhancement.There is no evidence of spinal stenosis or neural foraminal compromise.There is however a centrally located disk protrusion at the specialty with resultant mild flattening deformity of the thecal sac. There is also a large central and leftward disk protrusion at the L4 -- L5 level resulting in left lateral recess compromise.There is a tiny annular fissure at L5 -- S1 in the left paramedian location best appreciated on sagittal T2 series 38 image 11.
1.Pre--and post enhanced brain MRI demonstrating unremarkable intracranial content and without abnormal enhancement. Multiple foci of calvarial marrow signal replacement with enhancement are noted and highly suspected for metastatic disease.2.Pre-and post enhanced MRI of the cervical spine demonstrate uniform marrow signal changes of C2 and C3 vertebral bodies with mild diffuse enhancement suggestive of metastatic disease. Mild degenerative changes of the cervical spine without spinal stenosis or neural foraminal compromise. Normal signal intensity and caliber of cervical cord without abnormal enhancement.3.Pre-and post enhanced MRI of thoracic spine demonstrate marrow signal replacement with mild diffuse enhancement involving vertebral bodies and the posterior elements of T1 and T2 as detailed. Unremarkable exam otherwise.4.Pre-and post enhanced MRI of lumbosacral spine also demonstrate foci of marrow signal replacement with enhancement involving vertebral bodies of L1, L2, spinous processes of L3, body of L4 and L5 as well as S3 as detailed. Normal signal intensity of cauda equina and without abnormal enhancement. A small central disk protrusion at L2 -- 3 and a central and leftward disk protrusion at L4 -- L5 resulting in left lateral recess compromise.