Bladder cancer with new left lower extremity weakness Cervical: Craniocervical junction is unremarkable. Vertebral body heights in the cervical spine are normal. Alignment is maintained aside from straightening. No cord signal abnormality. There is moderate disc height loss at the C5-C6 level, particularly anteriorly. There is abnormal signal involving the left aspect of the C7 vertebral body with extension into the posterior elements suspicious for metastasis. No gross evidence of epidural tumor within the limits of noncontrast study.There is developmental narrowing of the cervical spinal canal with superimposed degenerative changes as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: Mild spinal canal stenosis which is on a developmental basis. Neural foramina are patent.C4-5: Developmental narrowing of the cervical spinal canal with superimposed small central disc protrusion. Mild facet arthropathy. There is moderate spinal canal stenosis. Neural foramina are patent.C5-6: Disc osteophyte complex with bilateral uncovertebral hypertrophy as well as ligamentum flavum thickening. There is moderate spinal canal stenosis and mild to moderate bilateral neural foraminal stenosis.C6-7: Disc osteophyte complex and uncovertebral hypertrophy as well as ligamentum flavum thickening. There is moderate spinal canal stenosis and mild to moderate bilateral neural foraminal stenosis.C7-T1: No significant compromise to the spinal canal or neural foramina.There is a 14 x 17 mm right lower cervical/level 4 lymph node which is also present on recent chest abdomen pelvis CT from 10/4/2016.Limited thoracolumbar spine evaluation on the cord compression protocol MRI: Scattered foci of osseous signal abnormality are seen including a 14 mm focus involving the L2 vertebral body as well as a lesion involving the spinous process of L5. There is also signal abnormality involving the posterior superior aspect of the T6 vertebral body.Vertebral bodies heights are maintained. Alignment in the thoracolumbar spine is maintained. There is T1 shortening involving the bone marrow of the pelvis and L5 level consistent with prior radiation. No large infiltrating lesions, pathologic fractures, or gross evidence of epidural tumor. No obvious cord signal abnormality. There are fairly mild multilevel degenerative changes with mild to moderate neural foraminal stenosis at the L4-L5 level. There is nonspecific edema involving the posterior paraspinous musculature from L3 to L5 level.
1. Examination of the spine includes sequences per acute cord compression protocol with additional noncontrast sagittal and axial T2-weighted sequences of the cervical spine. There is no evidence of acute cord or cauda equina compression.2. Scattered likely osseous metastatic lesions, relatively more prominent involving the C7 and L2 levels. No large destructive osseous lesions, pathologic fractures, or gross evidence of epidural tumor is appreciated.3. Developmental narrowing of the cervical spinal canal with superimposed degenerative changes resulting in moderate spinal canal stenosis at the C4-C5, C5-C6, and C6-C7 levels. No cord signal abnormality. 4. Enlarged lymph node in the right lower neck likely representing metastatic disease.5. Note due to the screening nature of the cord compression protocol details are not as evident on imaging as dedicated protocols of the spine.