 Compared to prior MRI lumbar spine dated 1/18/2016, there is worsened diffusely heterogeneous and infiltrative signal abnormality throughout the lumbar spine, partially imaged T11 and T12 levels, and partially imaged pelvis including the bilateral sacrum and iliac bones. There is also associated multifocal STIR hyperintensity and enhancement related to diffuse osseous metastatic disease which has significantly progressed. The degree of enhancement involving the S1 vertebral body has decreased in the interval as has the epidural tumor dorsal to the S1 vertebral body consistent with prior radiation treatment. For example at the L5-S1 level, previously seen epidural tumor measuring up to 5 mm in thickness now measures less than 1 mm. More ill-defined epidural enhancement along the anterior and right lateral aspect of the epidural space from the L5-S1 to S1-S2 levels also appears decreased. T1 hyperintensity involving the pelvis and lower aspect of the L5 vertebral body is consistent with prior radiation. Conjoined right L5, S1, and S2 nerve roots incidentally noted. There is increase in enhancement along the left anterolateral aspect of the L5 vertebral bodies suspicious for paraspinous tumor. There is minimal epidural enhancement along the dorsal aspect of the lumbar vertebral bodies which may represent venous plexus and less likely epidural tumor. There is no definite evidence of new epidural tumor since the prior study or leptomeningeal disease.There is linear T1 and T2 signal involving the S1 vertebral which is new and likely represents a pathologic fracture. Vertebral body heights are grossly preserved although there is progressive endplate deformity involving the inferior L5 and superior S1 endplates. The lumbar spine is in normal alignment, with straightening of the normal lumbar lordosis. There is no significant disc disease or spinal canal or neural foraminal stenosis.
1. Compared to MRI dated 1/18/2016, there has been marked progression of diffuse osseous metastatic disease throughout the lumbar spine and partially imaged pelvis. Previously seen enhancement associated with the S1 metastasis has decreased, and there is also decrease in epidural tumor at this level. There is however interval development of pathologic fracture involving the S1 vertebral body without significant loss of height.2. There is mild paraspinous tumor extension suspected along the left anterolateral aspect of the L5 vertebral body which is increased. No new epidural tumor is definitively appreciated. 3. There is no significant spinal canal or neural foraminal stenosis.