47-year-old female with breast cancer. Evaluate for metastases. MRI Cord compression assessment:With the benefit of full spine imaging, we identified 11 rib-bearing vertebral bodies which may change some vertebral body levels relative to prior exams. There is diffuse marrow replacement of many of the vertebral bodies within the spine, particularly involving the T6, L1, L3, L4 and L5 vertebral bodies, compatible with osseous metastases. There is evidence of kyphoplasty material at L1, L4 and L5. A compression deformity is again seen at L4 with some retropulsion of the fracture fragments as well as extensive epidural involvement of tumor which is unchanged compared to the recent previous CT. This causes severe compression on the thecal sac at this level. However there is no compromise to the spinal cord which terminates at the L1 level. The epidural spread of tumor posterior to the L1, L4 and L5 levels are described in detail on the dedicated MRI lumbar spine detail below. There is no definite evidence of intradural or leptomeningeal disease. Also noted on the sagittal imaging is a soft tissue mass involving the sternum compatible with metastatic disease as well as questionable soft tissue prominence around the great vessels in the mediastinum.MRI Lumbar Spine: Redemonstrated are areas diffuse bone marrow replacement, especially involving the L1, L3, L4, and L5 vertebral bodies consistent with metastatic disease. There is also involvement of the posterior elements at these levels. Some of the signal abnormality in the L1, L3, and L5 vertebral bodies is secondary to kyphoplasty material better seen on the recent lumbar spine CT. There is up to 70% height loss involving the L4 vertebral body consistent with pathologic fracture. There is minimal height loss involving the L5 vertebral body. Minimal osseous retropulsion is evident at the L1, L4, and L5 levels.L1-L2: There is diffuse marrow replacement and pathologic enhancement of the L1 vertebral body indicating metastatic disease but the vertebral body height is preserved. There is a mild degree of epidural extension which mildly effaces the ventral thecal sac but there is no significant central canal or neural foraminal stenosis.L2-3: There is no significant compromise to the neuroforamina or central canal.L3-4: There is almost complete involvement of the L3 vertebral body with tumor although the vertebral body height is within normal limits. There is evidence of epidural spread especially involving the right lateral recess and the right neural foramen with likely compromise of the neural foramen. There is moderate central spinal canal stenosis. The left neural foramen is not significantly narrowed. There is tumor extension into the right posterior spinal musculature at the L3-4 level.L4-5: There is complete marrow replacement of L4 indicating metastatic disease as well as severe compression deformity as described in the recent lumbar CT and which is unchanged. There is extensive paraspinal and epidural tumor which is circumferential within the spinal canal around the thecal sac. This causes severe spinal canal stenosis with impingement of the cauda equina and probable infiltration of the neural foramina to some degree. Also contributing at this level to the neural foraminal stenosis is facet degeneration. Anterior to the L4 vertebral body are several pathologic aortocaval lymph nodes. L5-S1: Diffuse involvement of the L5 vertebral body with tumor is seen as well as evidence of kyphoplasty. There is facet arthropathy which predominantly is the cause of neural foraminal narrowing bilaterally although a small amount of tumor could also be involved. There is no significant central spinal canal compromise at this level.There is significant marrow replacement involving the visualized bilateral iliac bones indicating evidence of tumor with increased extraosseous extension anteriorly along the left iliac wing invading the adjacent subcutaneous tissue, intra-abdominal space, and probably the left psoas muscle to some degree.MRI brain:There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.
1.With the benefit of full spine imaging, we identified 11 rib-bearing vertebral bodies which may change vertebral body numbering relative to the previous exam. 2.Findings compatible with widespread osseous metastatic disease especially involving the vertebral bodies of T6, L1, L3, 4, and L5. 3.Epidural spread of tumor especially involves the L4 level where there is circumferential involvement of the spinal canal and which causes severe spinal canal stenosis at this level. Anterior epidural spread of disease mildly narrows the L1 central canal level and moderately narrows the L5 central canal.4.Metastatic lesions involve the sternum and sacroiliac region, specifically the left iliac wing where there extraosseous extension anteriorly which invades the adjacent subcutaneous tissue, intra-abdominal space, and probably the left psoas muscle to some degree.5.Unchanged compression fracture of the L4 vertebral body.6.No evidence of intracranial disease.