Malignant neoplasm of unspecified site of unspecified female breast [C50.919], Reason for Study: ^Reason: Hx: metastatic breast cancer on letrozole and Denosumab now with worsening upper arm pain, not reproducible on exam. History: RUE pain that radiates C-Spine:The cranial-cervical junction is normal. There multilevel degenerative changes including disc dessication.The C7 vertebral body shows loss of normal bone marrow signal intensity indicating possible metastatic lesion which do not show any significant interval change since prior scan.C2 and C4 vertebral body show focal enhancement which again can represent focal metastatic lesion, no change since prior scan.There is no evidence of spinal cord signal abnormality.At the level of C34, there is broad based disc protrusion central to left which abuts thecal sac with minimal spinal canal stenosis.At the level of C45, broad based central disc bulging with ligamentum flavum thickening especially on the left side create mild to moderate spinal canal stenosis.At the level of C56, diffuse bulging of disc with ligamentum flavum thickening create mild to moderate spinal canal stenosis. In addition, there is moderate to severe neuroforaminal stenosis on the left side and mild neuroforaminal stenosis on the right.At the level of C67, there is broad based disc protrusion toward right side lateral recess creating right side lateral recess narrowing with possible compression of the right side nerve root. There is left side neuroforaminal narrowing due to uncovertebral joint hypertrophy.Thoracic spine:The pattern of metastatic lesions on thoracic vertebral bodies appear to be changed significantly.In particular, previously seen diffuse vertebral body involving lesions are now more likely confined appearance. There also interval development of compression fractures on T4 (about 10%), T6 (about 10%), T9 (about 15%) and T11 (about 5%). The large extruded disc at the level of T67 which abuts thecal sac and spinal cord do not show any significant interval change since piror scan. There is left side ligamentum flavum thickening at the level of T9-T10 which creates minimal spinal canal narrowing. Except the level of T67 and T9-T10, there is no evidence of spinal canal narrowing.There is no evidence of abnormal signal intensity of the spinal cord.Lumbar spine Again multiple vertebral body metastatic lesions were seen which demonstrate interval change.The patterns of interval changes are similar to those of thoracic spine. Specifically, those seen as diffuse vertebral body involvement is now showing more confined lesion with development of interval compression fracture of L2 (about 30%) as well as L3 and L4 endplate fractures.However, the S1 vertebral body shows a bit more progressed vertebral body involvement comparing to prior study.Disc dessication was seen in all lumbar spine with ligamentum flavum thickening indicating degenerative changes. In particular, at the level of L34 and L45, there is mild to minimal spinal canal narrowing. Diffuse involvement of bilateral ilium and remained sacrum.Spinal cord signal intensity appears to be normal without evidence of abnormal enhancement.The conus medullaris terminates at the L1 level.
1. Interval change of pattern of vertebral body metastasis on both thoracic and lumbar spine, specifically the lesions appear to be more confined and developed various degree of compression fractures as described above.2. Multi-level various degree degenerative changes especially cervical spine including spinal canal stenosis and neuroforaminal stenosis.3. No change of T67 intervertebral disc extrusion since prior scan.4. Interval progression of S1 vertebral metastatic lesion comparing to prior scan. 