Clinical question: History of cervical cancer, new lower extremity weakness concern for spine metastases and cord compression. Signs and symptoms: As above. Pre and post enhanced cervical MRI:There is normal anatomical alignment of cervical spine and with normal signal intensity without abnormal enhancement to suggest metastatic disease. The signal intensity and caliber of cervical cord is also within normal and without abnormal enhancement.There is generalized smaller than expected caliber of the spinal canal which is believed to be at least partially secondary to congenitally small canal. This finding in combination with mild degenerative disease results in multilevel mild central spinal stenosis.Foramen magnum is unremarkable.C2-C3 demonstrate mild degenerative changes with resultant mild central spinal stenosis without neural foraminal compromise.C3-C4 demonstrate mild degenerative changes, tiny central disc protrusion and mild buckling of the hypertrophy ligamentum flavum. Constellation of a marked changes results in mild central spinal stenosis without neural foraminal compromiseC4-C5 demonstrate mild degenerative changes with resultant mild central spinal stenosis.C5-C6 demonstrate moderate disc disease and mild facet/ligamentum flavum hypertrophy with resultant moderate left and mild right neural foraminal compromise.C6/C7 demonstrate moderate disc disease and loss of disc height, moderate left neural foraminal compromise and no central spinal stenosis.C7-T1 demonstrate no spinal stenosis or neural foraminal compromise.The post enhanced thoracic MRI:Examination demonstrates mild exaggeration of thoracic kyphosis likely secondary to degenerative disease. The alignment and the signal intensity of vertebral column remains within normal and there is no evidence of abnormal enhancement to suggest metastatic disease.The signal intensity and caliber of the thoracic cord is also within normal limits and without abnormal enhancement.There is no evidence of spinal canal compromise/stenosis or cord compression at any level. No significant degenerative disease and no evidence of neural foraminal compromise.Note is made of a bilateral pleural effusion measuring at least 27 mm on the right and 34 mm thick on the left.Pre and post enhanced lumbar MRI:Examination demonstrates normal anatomical alignment of vertebral column. There is no evidence of spinal canal compromise at any level.There is normal signal intensity and caliber of the lower most visualized thoracic cord, conus and the cauda equina without abnormal enhancement to suggest metastatic disease.There is uniform marrow signal abnormality of L5 through S4 with T1 hyperintense and T2 hyperintense signal pattern consistent with prior radiation therapy for cervical cancer.There is also extensive soft tissue along the presacral space with enhancement. Although it is difficult to precisely compare this exam with prior CT of abdomen and pelvis there is suggestion of possible interval increase in size of the soft tissue. Several irregularity within the S2 vertebral body with enhancement is also present which could represent post radiation change/necrosis however possibility of localized tumor or an infectious process cannot be entirely excluded considering patient's history of post radiation therapy complication and endovaginal fistula.
1.Examination of cervical spine demonstrate no evidence of metastatic disease or cord compression. Multilevel mild central spinal stenosis secondary to mild degenerative disc disease and suspected congenitally small canal as detailed.2.Examination of the thoracic spine demonstrate no evidence of metastatic disease. No evidence of spinal canal compromise, stenosis or cord compression. Bilateral pleural effusion (left greater than right) is noted as detailed/measured above.3.Examination of the lumbosacral spine demonstrate no evidence of spinal canal compromise or mass effect on the conus and cauda equina. No detectable abnormal enhancement of the conus or the cauda equina. Uniform signal changes of L5 through S2 consistent with prior radiation therapy. Increased presacral soft tissues at the site of prior surgery and radiation changes for cervical cancer. Small focus of irregularity within the S2 vertebral body with subtle enhancement could represent postradiation change/necrosis with other differentials of localized tumor recurrence or infection as possibilities. This finding is not associated with any epidural soft thickening or enhancement.