Female, 71 years old, with remote history of squamous cell carcinoma of the supraglottic larynx, and more recent history of lung adenocarcinoma, with focus of abnormal uptake seen within L5 on prior PET scanning. Assess for metastatic disease. On a background of heterogeneous marrow, there are numerous focal areas of pathologic marrow replacement within the osseous structures of the lumbar spine. A lesion is indeed seen within the right aspect of the L5 vertebral body correlating to an area of abnormal PET hypermetabolism. However, multiple additional foci are seen in nearly every other vertebral body as well. No evidence of extraosseous or epidural disease extension is seen.Spinal alignment is anatomic. Vertebral body heights are preserved. There is a transitional morphology of the L5 vertebral body. The visualized distal spinal cord, conus and nerve roots of the cauda equina demonstrate normal signal characteristics. No epidural abnormalities are suspected.L1-2: Unremarkable. L2-3: Unremarkable. L3-4: Mild loss of disc height and mild disc bulging. Mild to moderate generalized spinal canal narrowing. Mild bilateral foraminal narrowing. L4-5: Mild facet hypertrophy and ligamentum flavum thickening. Mild bulging disc with a small superimposed central protrusion. Moderate generalized spinal canal stenosis. Mild right foraminal narrowing. L5-S1: Moderate left and mild right facet hypertrophy. Very small central annular disc fissure. No significant spinal canal stenosis. No foraminal narrowing.
1.Numerous foci of pathologic marrow replacement are seen within nearly every vertebral body level of the visualized lumbar spine. Given the history, these are highly suspicious for metastatic deposits. No evidence of any significant extraosseous or epidural disease extension is seen.2.Multilevel degenerative findings are noted as above. Specifically, there is a mild to moderate spinal canal stenosis at L3-4, and a moderate spinal canal stenosis at L4-5.