Clinical question: Patient with new symptoms onset of lower extremity weakness; reevaluate for disease progression. Signs and symptoms: Stage IV Melanoma. Pre and post enhanced lumbar MRI:There is normal anatomical alignment of the vertebral column.There is however significant diffuse marrow signal abnormality of the entire visualized osseous structures of the study. On post enhanced images there are numerous varying size foci of enhancement involving the vertebral bodies, pedicles and the posterior elements of the lumbosacral spine corresponding to regions of T2/T2 STIR hyperintensity and consistent with diffuse tumor involvement.There is no evidence of fracture or malalignment. There is also no detectable extraosseous spread of tumor into the dural space or the paravertebral soft tissues.The signal intensity of the lower most visualized cord, conus and the cauda equina is within normal and without abnormal enhancement.There is also small well-demarcated enhancing mass in the pelvis on the left anterior to the left iliac wing measuring 12 x 12.5 mm (axial T2 and axial post enhanced series on image 8).
1.Diffuse marrow signal abnormality of the entire visualized bony structures of the lumbosacral spine and pelvis with numerous internal varying size foci of enhancement consistent with diffuse metastatic disease. No definitive extraosseous spread of tumor.2.No evidence of leptomeningeal enhancement.3.No evidence of fracture or malalignment.4.Small enhancing mass in the left pelvis anterior to the left iliac wing as mentioned/measured above.