55-year-old man with history of back pain, compression fractures, and squamous cell carcinoma of the tongue. Thoracic Spine: There is diffusely increased T2 and decreased T1 signal in multiple cervical and thoracic vertebral bodies. In particular, the T3 vertebral body is collapsed with greater than 50% loss of height anteriorly, which is similar in appearance to 1/18/2016. Furthermore, at the T1 through T5 levels, there is apparent epidural tumor extending into the thecal sac, with compression of the spinal cord at the T4 level, and bilateral neural foramina, as well as extension of tumor into the paraspinous soft tissues. There is also abnormal bone marrow signal in the T10 vertebral with extension into the anterior epidural space and right neural foramen, but no spinal cord compression at this level. There are multiple bilateral perinephric tumors. In addition, there are enlarged cervical and upper mediastinal nodes. There appears to be debris in the trachea and pulmonary atelectasis. There is no spondylolisthesis.Lumbar Spine: Five lumbar type vertebral bodies are presumed to be present. There is high T2 and low T1 signal diffusely within in the L2 vertebral body, sacrum, and bilateral ilia. Furthermore, there appears to be epidural extension of tumor from the posterior L2 vertebral body into the right lateral recess and neural foramen, causing significant stenosis. Also, at the S1 level, there is partially imaged tumor in the central anterior epidural space, which is partially imaged, but pushes the thecal sac posteriorly. The vertebral body heights are preserved and the alignment is within normal limits. There is an intradural, extramedullary lesion in the thecal sac at the L3/L4 level measuring 27 x 18 x 16 mm with compression of the cauda equina nerve roots. There are multiple tumors within the right psoas muscle and bilateral retroperitoneal regions. There is mild degenerative spondylosis in the lower lumbar spine.
1.Multiple osseous metastases involving the axial skeleton, including a pathologic compression fracture of T3 and epidural tumor at T1 through T5 with compression of the spinal cord at the T4 level, and a metastasis in the thecal sac at the L3/L4 level with compression of the cauda equina nerve roots. However, assessment of metastatic disease is somewhat limited by the lack of intravenous contrast.2.Multiple abdominal and thoracic metastases. Please refer to the recent body CT for additional details.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.