Clinical question: 75-year-old male with persistent left-sided back pain in the lower thoracic and high lumbar region. Signs and symptoms: As above. Nonenhanced thoracic MRI:Examination demonstrates multiple foci of marrow signal replacement consistent with metastatic disease throughout the thoracic spine and partially visualized C7. Findings involve the vertebral bodies and posterior elements. The largest metastatic lesion involves the vertebral body of T9 which also extends to bilateral posterior elements and articulating facets (left greater than right). There is evidence of significant epidural spread of tumor at this level on the left both posteriorly and anteriorly which results in significant mass effect on the cord and central spinal stenosis. The signal intensity of the cord cannot be properly assessed due to significant mass effect. Tumor at this level also extensively involves the T8-T9 and T9-T10 neural foraminal on the left and patent neural foramen on the right.All other small metastatic lesions remain intraosseous and without detectable spread into the epidural space or perispinal soft tissues. Metastatic lesions are present in vertebral body of C7, vertebral body of T3 and its posterior elements, posterior element of T5, vertebral body of T7, vertebral body of T8 and its posterior elements, vertebral body of T10, vertebral body of T11, vertebral body of T10 and its posterior elements. No evidence of spinal canal compromise at any other level.Nonenhanced lumbar MRI:This examination also demonstrates extensive osseous metastatic lesions involving vertebral bodies and posterior elements. The lesion appear to be entirely intraosseous and without convincing evidence of spread into the epidural space on this nonenhanced exam. The largest metastatic lesion involves vertebral body of T5. There are however metastatic lesions present throughout the lumbar and visualized sacral spine.There is no evidence of central spinal stenosis at any level. Moderate to advanced degenerative disc disease and moderate to significant hypertrophic changes of posterior elements in the lower lumbar spine is noted. There is significant right neural foraminal compromise at L4-L5 secondary to degenerative changes.DR. Amid Patel patient's cardiologist and Dr. Susan Hong primary care physician covering for Dr. Diane L. Altkorn were notified by phone of the findings and concerns on this study at the time of review of exam.
1.Nonenhanced MRI of the thoracic spine demonstrate extensive osseous metastatic lesions involving vertebral bodies and the posterior elements as detailed. The largest metastatic lesion involves extensively the T9 vertebrae and with extension posteriorly into bilateral pedicles and articulating facets (left greater than right). Epidural extension of tumor on the left with resultant significant central spinal stenosis and mass effect on the cord as detailed. None of the other diffuse metastatic lesion demonstrate extension into the spinal canal and no central spinal stenosis. Please review detailed report above.2.Nonenhanced MRI of lumbar spine demonstrate diffuse osseous metastatic lesions of the vertebral bodies and posterior elements without convincing evidence of extraosseous spread into the spinal canal or the perispinal soft tissues. Extensive degenerative changes of lumbar spine without convincing evidence of central spinal stenosis. Neural foraminal compromise however is detected.