Clinical question: Rule out brain metastases. Signs and symptoms: Known spinal cancer. Pre and post contrast brain MRI: Negative diffusion weighted images.Examination demonstrate normal anatomic cord morphology and with normal signal intensity on all MRI sequences. Unremarkable sacral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination.There is no detectable abnormal parenchymal or leptomeningeal enhancement to suggest metastatic disease.Normal signal intensity of calvarium and without abnormal enhancement.Unremarkable images through the orbits and including axial fat sat post enhanced series.On paranasal sinuses and bilateral mastoid air cells and middle ear cavities demonstrate normal pneumatization signal pattern.Nonenhanced total spine MRI:Examination is performed utilizing cord compression protocol which does not include axial images and without contrast.Within this limitation there is normal anatomical alignment of vertebral column. There is no evidence of mass effect on the cord or central spinal stenosis at any level.Marrow signal replacement involving the posterior articulating facet of T8 as well as diffusely involving vertebral body of L2, L3 and partial involvement of anterior body of S1 on highly suspected for osseous metastatic lesions. There is mild compression deformity of the superior endplate of L2 with subtle bulge of the compressed vertebra into the spinal canal.The signal intensity and caliber of the cord as well as cauda equina remains within normal and is nonenhanced study.Pre and post enhanced lumbosacral MRI:There is diffuse marrow signal replacement involving the vertebral body of L2 and left pedicle with enhancement consistent with metastatic disease. There is mild compression deformity of superior endplate of L2 and evidence of ventral epidural spread of tumor at this level which also extends into the left neural foraminal with resultant compromise. There is however no spinal stenosis.Metastatic lesion is also noted involving extensively the vertebral body of L3 and left pedicle with enhancement. There is no evidence of fracture or malalignment and no central spinal stenosis or neural foraminal compromise.Small focus of marrow signal replacement with enhancement involves the anterior-inferior aspect of S2 vertebral body consistent with metastatic lesion. No epidural spread of tumor.Normal signal intensity and caliber of the lower most visualized thoracic cord, conus and cauda equina without abnormal enhancement.Note is also made of marrow signal replacement with enhancement involving the left iliac wing measuring at 13 x 22 and right iliac wing measuring 7 x 6 mm consistent with additional osseous metastatic lesions.
1.Negative pre and post enhanced brain MRI.2.Nonenhanced cord compression complete spine MRI demonstrate no cord compression. There are however multiple osseous metastatic lesions present. There is metastatic lesion involving L2 vertebrae and with mild compression fracture of superior endplate. Normal signal intensity and caliber of the cord and without evidence of spinal canal compromise or stenosis at any level.3.Pre and post enhanced MRI of lumbar spine demonstrate metastatic lesions involving extensively vertebral body of L2 and L3 and to a lesser degree anterior body of S1 and with lesions in bilateral iliac wings (L>R) as detailed as detailed/measured above. Mild compression fracture of superior endplate of L2 vertebrae with metastases. There is extraosseous spread of tumor into the ventral epidural space at L2 and with extension and compromise of the left lateral recess and left neural foramina at L2-L3 as detailed. No central spinal stenosis or leptomeningeal enhancement.