Metastatic renal cell cancer status post thoracolumbar surgery for tumor decompression and fusion. Evaluate for change to residual or recurrent tumor. Thoracic: Again seen are postsurgical changes of spinal fusion with thoracic hardware extending from T7 to T12 with bilateral paraspinous rods and bilateral pedicle screws at the T7, T8, T11, and T12 levels. There is evidence of decompressive laminectomies from T8 to T10. Postsurgical changes in the lumbar spine are described in the section below. Compared to 9/23/2015, there is no significant change in extensive marrow infiltration involving the T9 vertebral body with extension into the posterior elements as well as the ventral epidural space, with resulting complete effacement of the ventral thecal sac. Dorsal thecal sac is preserved without evidence of significant mass effect on the cord at this level. Again seen is moderate narrowing of the right T9-T10 neural foramen related to tumor and not significantly changed since prior. There has been interval increase in diffuse tumor infiltration at the T3 level. The T3 lesion previously measuring 4.9 x 2.7 cm now measures 5.2 x 6.4 cm in the AP and transverse dimensions (axial T2 image 23 or series 1001) and involves the left aspect of the vertebral body, pedicles, lamina, and transverse process and extends laterally along the left chest wall. Besides the increased vertebral involvement, there is also new epidural tumor effacing the left lateral aspect of the thecal sac and mild associated deformity of the cord. There is also development of moderate to severe neural foraminal stenosis involving the left T2-T3 and T3-T4 neural foramina. No new cord signal abnormality.Tumor infiltration involving the T10 vertebral body is not significantly changed. There is a small lesion involving the left T1 transverse process also similar to prior.Pathologic fracture with mild loss of height of the T9 vertebral body and mild osseous retropulsion is not significantly changed. Vertebral body heights and alignment are otherwise grossly preserved in the thoracic spine. Adrenal nodules and evidence of left nephrectomy again seen and better assessed on recent CT.Lumbar: Postsurgical changes in the thoracic spine continue into the lumbar spine with paraspinous rods and bilateral pedicle screws at the L2 and L3 levels. Partial corpectomy with graft placement again noted at the L1 level. Laminectomy at T12 and at L1 for spinal canal decompression also again seen.Tumor infiltration involving the residual L1 vertebral body is again seen. Susceptibility artifact limits evaluation however finding is not significantly changed. Mild compression fracture involving the L1 vertebral body is also not significantly changed. Elsewhere in the lumbar spine, no definite evidence of new or progressive marrow signal abnormality is seen. No findings to suggest epidural or leptomeningeal disease in the lumbar spine. Partially imaged pelvis demonstrates enlargement of bilateral iliac wing and right sacral lytic lesions. There appears to be increased tumor infiltration involving the neural foramina of the right S1 and S2 nerve roots.Aside from the mild compression fracture of L1, vertebral body heights are preserved. Alignment is grossly preserved aside from mild reversal of lordosis at the L3 level. There is mild to moderate narrowing of the right T12-L1 and L1-L2 neural foramen related to tumor. There is also mild narrowing of the left L4-L5 and right L5-S1 neural foramina on a degenerative basis.
1. Compared to 9/23/2015 there has been progression of metastatic disease, particularly at the T3 level where there is increased vertebral involvement and increased epidural tumor effacing the left lateral aspect of the thecal sac with mild associated deformity of the cord. No evidence of frank cord compression or cord signal abnormality. There is also increased tumor involving the left T2-T3 and T3-T4 neural foramina.2. Interval progression of tumor within the partially visualized right sacrum and bilateral iliac bones. There appears to be increased tumor infiltration surrounding the right S1 and S2 nerve roots in the neural foramina.3. Postsurgical changes related to spinal canal decompression and fusion are again seen. There remains effacement of the ventral thecal sac related to epidural tumor at the T9 level similar to prior. Spinal canal is surgically decompressed posteriorly at this level.4. Additional foci of tumor are not significantly changed. Mild pathologic fractures involving the T9 and L1 vertebral bodies are not significant changed. Please see details above.