75 years Male (DOB: 1/19/1941)Reason: r/o metastatic disease History: hyperreflexic BLE, c/f upper motor neuron processPROVIDER NAME: THOMAS F. GAJEWSKI THOMAS F. GAJEWSKI MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. There is asymmetry of the lateral ventricles of the right being larger than the left. There is a 15 mm arachnoid cyst in the right middle cranial fossa.Some opacification at the right jugular bulb on T2 and FLAIR imaging is a nonspecific finding which could simply be related to slow flow.There is a T2 signal hyperintense lesion in T1 and FLAIR hypointense lesion located in the left basal ganglia which likely represents an expanded perivascular spaceNo abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The right high lens is thin.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal enhancing lesions are identified in the cervical spine. There is multilevel disc desiccation present.There is an 11 x 15 mm sagittal dimension enhancing lesion along the posterior aspect of the T2 vertebral body associated with adjacent signal change.At C2-3 there is no significant compromise to the spinal canal or neural foramina. There is mild facet hypertrophy at this level.At C3-4 there is mild to moderate facet hypertrophy present bilaterally at this level but more on the left versus the right side. There are bilateral uncovertebral osteophytes present at this level associated with the effacement of fat surrounding the exiting nerve roots bilaterally. The nerve root encroachment appears to be worse on the left compared to the right side. There is partial effacement of spinal fluid ventral to the spinal cord at this level. Overall there is a mild degree of spinal stenosis presentAt C4-5 there is mild facet hypertrophy present bilaterally at this level but more on the left versus the right side. There are bilateral uncovertebral osteophytes present at this level associated with the effacement of fat surrounding the exiting nerve roots bilaterally. The nerve root encroachment appears to be worse on the left compared to the right side. There is partial effacement of spinal fluid ventral to the spinal cord at this level. Overall there is a mild degree of spinal stenosis presentAt C5-6 there is a disc bulge present at this level associated with some mild effacement of spinal fluid ventral and posterior the spinal cord and mild narrowing of the neural foramina but no significant compromise to spinal canal or exiting nerve roots.At C6-7 there is a disc bulge present at this level associated with some mild effacement of spinal fluid ventral and posterior the spinal cord and mild narrowing of the neural foramina but no significant compromise to spinal canal or exiting nerve roots.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. The right vertebral artery flow-void is not readily identified.Thoracic spine:The overall marrow signal of the lower thoracic spine from T6 through T12 on T1-weighted imaging is high suggesting prior radiation treatment. There are marrow replacing and contrast enhancement lesions present at T2, T7, T10 and T11.The lesion at T2 along the posterior aspect of the vertebral body measures 11 x 15 mm sagittal dimensions. The one at T7 measures 16 x 15 mm sagittal dimensions with a second lesion adjacent to and involving the right pedicle of T7 measuring 30 x 22 mm sagittal dimensions and a third lesion in the right pedicle measuring 12 x 17 mm sagittal dimensions. The lesion at T10 measures 5 mm and is adjacent to the superior endplate. The lesion at T11 is associated with approximately 60% loss of vertebral body height and mild retropulsion. There is some narrowing of the T11-T12 neural foramina present, however, the exiting nerve roots are still surrounded by fat.There is no compromise of thoracic spinal canal or exiting nerve roots. There are small pleural effusions present.Lumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. No contrast enhancing lesions present at L3 and L4 as well as S1 the one at L3 is not the right posterior lateral aspect of the vertebral body and measures approximately 12 mm and is associated with the right anterolateral lesion measuring 13 mm. 1's at L4 are present measuring 16 mm and another measuring 13 mm. There are punctate lesions present in L5 and the lesion at S1 measuring 13 mm.Another lesion is present in the left iliac bone which enhances with contrast and measures approximately 30 x 14 mm. One in the right iliac bone measures 30 x 14 mm axial dimensions.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is a disc bulge present at this level. There is some disc desiccation at this level. There is mild facet hypertrophy at this level.At L4-5 there is there is some disc desiccation and a disc bulge present at this level associated with some ligamentum flavum hypertrophy bilaterally. There is effacement of the fat at the left lateral recess at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.The left kidney is not readily identified.
1.There are multiple lesions present in the thoracic and lumbar spines as well as the visualized sacrum and iliac bones compatible with metastatic disease as detailed above.2.There is a malignant compression fracture present at T11 with mild retropulsion but no significant compromise to the spinal canal at this time.3.There is no evidence for brain metastases on the basis of this exam.4.The right vertebral artery flow-void is not readily identified throughout its course suggesting possible occlusion along the cervical segment.5.There are some degenerative changes present in the cervical spine with neural foramen encroachment as detailed above.6.There are some mild degenerative changes present in the lumbar spine without significant compromise to spinal canal or exiting nerve roots.7.There are small pleural effusions present.