Female, 51 years old, with synovial sarcoma metastatic to the spinal cord status post resection, three-month surveillance examination for recurrence. Brain:A few scattered foci of parenchymal T2 hyperintensity are demonstrated, a finding which is stable and nonspecific. No evidence of edema or mass effect is seen. No pathologic parenchymal or extra-axial enhancement is observed. No intracranial hemorrhage or any abnormal extra axial fluid collection is seen. The ventricles are normal in size and morphology.Cervical spine:Alignment is anatomic. Vertebral body height and morphology are within normal limits. No pathologic marrow replacement or enhancement is seen. The visualized spinal cord shows normal signal intensity and morphology. No intramedullary or leptomeningeal enhancement is detected. The intervertebral discs are preserved no evidence of significant spinal canal or foraminal stenosis.Thoracic spine:Evidence of laminectomy is again seen from T4 through T6. Epidural and paraspinal fluid has decreased in the operative region. A cavity-like area of T2 hyperintensity is seen within the spinal cord at the T4-5 level representing the site of tumor resection. There is minimal surrounding edema and prominence of the central canal spinal cord above and below this cavity. No pathologic enhancement is seen at the operative site or elsewhere along the thoracic spinal cord.The thoracic kyphosis is slightly exaggerated but sagittal alignment is unremarkable. Vertebral body height and morphology are within normal limits. Marrow signal characteristics are compatible with prior radiotherapy. No suspicious focal or enhancing marrow space lesions are seen. The intervertebral discs are preserved with no evidence of significant spinal canal or foraminal stenosis.Volume loss of the right hemithorax is seen. There is pleural thickening and an area of probable round atelectasis in the right lower lobe. Defects in several right sided ribs are seen likely reflecting prior surgery. However, an enhancing lesion which measures up to 15 mm in size is seen along the posterior ribs at the T5 level appears to be new from prior.Lumbar spine:There is a mild scoliotic curvature of the lumbar spine. Sagittal alignment is unremarkable. Vertebral body height and morphology are within normal limits. No concerning marrow replacement or pathologic marrow enhancement is seen. The visualized spinal cord, conus and cauda equina are within normal limits. No pathologic intrathecal enhancement is detected. The intervertebral discs are preserved with no definite bulging or herniation seen and no significant spinal canal or foraminal stenosis. Moderate facet arthropathy develops at lower lumbar levels.The right paraspinal musculature is edematous in the upper lumbar region. In addition, there are at least two enhancing nodules within or adjacent to the right paraspinal musculature. The larger lesion is located posterior to the right kidney and measures up to 15 mm. These lesions appear to be new from prior.
1.Resolving postoperative findings are seen compatible with resection of a tumor from the thoracic spinal cord.2.At the site of tumor resection, there is a small cavity and mild edema in the surrounding cord, but no pathologic enhancement to suggest residual or recurrent tumor.3.New enhancing soft tissue masses are seen along the right posterior ribs at the T5 level, as well as several enhancing nodules within the right lumbar paraspinal region. These are concerning for new metastatic deposits. Dedicated chest and abdominal imaging is suggested to better assess the extent of disease.4.No evidence of metastatic disease is seen in the cervical spine or the brain.