Metastatic breast cancer with compression fracture. Increasing low back pain. The extensive metastatic involvement through the lumbar and included lower thoracic spine is now more T1/T2 hypointense and less contrast-enhancing which may reflect treatment response. The associated compression fractures at L4 and L5 as well as T12 have increased. There is severe height loss at T12 and L5, at 70% and 75% percent/ respectively. There is thickening of the soft tissue posterior to the compressed L5 vertebral body suggesting a small epidural component which now indents the thecal sac and the left lateral/subarticular recess. There is also slightly increased compression of the thecal sac at T12 level related to retropulsion, although without spinal cord compression.T11-T12: The increased T12 compression fracture is associated with moderate left and mild right foraminal narrowing. There is mild mass effect on the thecal sac related to retropulsion at T12 level but no spinal cord compression.T12-L1: There is mild-to-moderate left and mild right neural foraminal narrowing but no spinal canal narrowing.L1-L2 and L2-L3: There is no significant spinal canal or neural foraminal narrowing.L3-L4 and L4-5: There is minimal bilateral neural foraminal narrowing. No significant spinal canal narrowing.L5-S1: There is slightly increased narrowing of the left lateral recess and proximal neural foramen. Otherwise no significant spinal canal or neural foraminal stenosis. Linear T2 hyperintensity involving the posterior aspect of the disc, mainly to the left of midline, may represent an annular fissure.The metastatic involvement of the iliac bones is slightly more discretely T1-hypointense compared to the previous examination.Extensive liver metastatic involvement is only partly imaged.Again seen is epidural enhancement dorsal to the L5 vertebral body which may represent small amount of epidural tumor, although some of this enhancement likely represents epidural venous plexus. No significant associated stenosis.
1.Diffuse osseous metastatic disease with slight differences in associated signal abnormalities compared to 2/9/2015 including decrease in enhancement, findings overall representing treatment response. Please note however given the extensive osseous metastatic disease, follow-up bone scan may be helpful to assess for changes in the overall burden of osseous metastatic disease. 2.Pathologic compression fractures at T12, L4 and L5 are worse in the interval. There is also increased osseous retropulsion particularly at T12, where there is mild spinal canal stenosis without frank cord compression.3.Minimal ventral epidural tumor is suspected at the L5 level which is slightly more prominent than before but without significant spinal canal stenosis.