61-year-old female with neck, back and shoulder pain. Evaluate four lytic bone lesion. MRI C-Spine:An avidly enhancing soft tissue mass is redemonstrated involving the left C7 transverse process, pedicle and lamina. The lesion certainly encroaches upon the left C6-7 and C7-T1 neural foramina. However the lesion is most likely osseous in origin, and is best as can be determined, seems to be separate from the exiting nerve nerve roots. There is no significant intraspinal epidural encroachment. Much smaller but similar-appearing enhancing lesions are also evident within the spinous processes of C5 and T1. The cervical spinal cord has normal signal characteristics and overall morphology. The vertebral artery flow voids appear to be intact. There is a normal variant enlarged foramen transversarium secondary to mildly hypertrophied/tortuous vertebral artery involving the left C3 level. The paraspinous soft tissue structures appear within normal limits.The craniovertebral junction appears within normal limits. The cervical spine alignment is maintained and the cervical vertebral bodies are appropriate in height. There is multilevel disc height loss most prominently involving the lower cervical spine at C5-6. There are small disc osteophyte complexes at multiple levels in the cervical spine extending from C3-4 through C6-7. Facet hypertrophy and ligamentum flavum thickening involving the C5-6 and C6-7 levels along with the disc osteophyte complexes at these level causes mild spinal canal stenosis. There is moderate bilateral neural foraminal narrowing involving C5-6 level. The left C6-7 and C7-T1 neural foramina are narrowed due to a combination of tumor and degenerative change.MRI Cord Compression Protocol:No acute cord compression is seen. In addition to the above-mentioned findings, there also appears to be a small focal STIR hyperintense lesion within the inferior articulating facet of T12 on the right.
A solidly enhancing, expansile mass is present centered on the left C7 transverse process, pedicle and lamina. Although the adjacent neural foramina are compromised by this lesion, there is no significant intraspinal epidural involvement. Additional small lesions are also seen within the spinous processes of C5 and T1, and the right inferior articulating facet of T12. No acute cord compression is detected at any level.Given the relatively aggressive appearance on CT, and the multiplicity of lesions, the possibility of a malignant process must be considered. Metastatic disease, myeloma and lymphoma would be in the differential diagnosis. The possibility of a benign lesion is not entirely excluded, though this is considered less likely.Findings were relayed to Dr. Castro, of Neurosurgery service, by Dr. Veronesi, Neuroradiology Fellow, on 10/30/2016 at 11 am.