Stage IV lung cancer now with increasing right lower back pain. Evaluate extent of bone metastases. Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The bone marrow is diffusely heterogeneous which may be secondary to treatment change. In addition, there are multiple T2 hyperintense foci throughout the visualized thoracolumbar spine are compatible with osseous metastases. The largest lesion is incompletely visualized within the posterior T11 vertebral body which extends to partially involve the right pedicle. There are also additional lesion suspicious for metastasis in the posterior superior endplate of the L3 vertebral body, the posterior S1 vertebral body and S3 vertebral body. There is no extraosseous spread of tumor, pathologic fracture or central spinal canal compromise. The conus medullaris on sagittal imaging is grossly intact.T12-L1 through L2-L3: There is no significant compromise to spinal canal or neural foramina.L3-L4: Mild disc disease is noted with evidence of a small midline posterior annular fissure. There is minimal grade 1 retrolisthesis of L3 on L4 which causes mild to moderate right and mild left neural foraminal stenosis as well as mild central canal stenosis.L4-5: Mild disc disease is noted with a tiny linear T2 hyperintense signal within the posterior annulus of the disc compatible with a fissure. There is mild bilateral facet hypertrophy with small facet joint effusions as well as moderate bilateral ligamentum flavum thickening. This causes mild central canal stenosis. There is also moderate bilateral right greater than left neural foraminal stenosis as well as bilateral lateral recess compromise which may impinge the L5 nerve root. A degenerative Schmorl's node is noted in the inferior endplate of L4.L5-S1: No significant disc disease and mild bilateral facet hypertrophy. No neuroforaminal or central spinal canal stenosis.Two enhancing lesions are noted within the left iliac wing compatible with metastases.
1.Metastatic osseous lesions involving several lower thoracic and lumbosacral vertebral levels as well as the left iliac wing.2.Multilevel degenerative changes as described above, most severe at the L3-4 and L4-5 levels.