67-year-old male with a history of of hepatocellular carcinoma with lower back pain. Evaluate for metastatic lesion. MRI C-Spine:There is diffuse heterogeneity of the bone marrow which is nonspecific. No evidence of osseous edema or abnormal enhancement to definitively indicate tumor. The craniovertebral junction appears within normal limits. There is mild reversal of cervical lordosis of the cervical spine. The cervical vertebral bodies are appropriate in height. There is multilevel disc height loss, most prominently involving the C3-4, C4-5, and C5-6 levels. The cervical spinal cord has normal signal characteristics and overall morphology. The vertebral artery flow voids appear to be intact. There is a subcutaneous lipoma involving the posterior subcutaneous soft tissues at the C4-C5 level. The paraspinous soft tissue structures appear otherwise within normal limits.Interspace observations:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: Disc osteophyte complex and uncovertebral and facet hypertrophy. There is effacement of the ventral thecal sac, otherwise no significant spinal canal stenosis. Mild bilateral neural foraminal narrowing. C4-5: Disc osteophyte complex and uncovertebral and facet hypertrophy. There is effacement of the ventral thecal sac, otherwise no significant spinal canal stenosis. Mild to moderate bilateral neural foraminal stenosis.C5-6: Disc osteophyte complex, uncovertebral and facet hypertrophy and ligamentum flavum thickening. Mild spinal canal stenosis. Moderate to severe right neural foraminal stenosis. Left neural foramen is patent.C6-7 and C7-T1: No significant compromise to the spinal canal or neural foramina.MRI T-Spine:There is diffuse heterogeneity of the bone marrow which is nonspecific. There is STIR hyperintensity and enhancement involving the right T3 transverse process may represent an osseous metastatic lesion but nonspecific. There is questionable intrinsic T1 hyperintensity.The thoracic spine is in normal alignment. The vertebral body and disk heights are well-maintained. The spinal cord is of normal caliber and signal. There is no pathological intramedullary or epidural enhancement. There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the thoracic spine.
1.Focal STIR hyperintensity and enhancement involving the right T3 transverse process may represent a hemangioma versus a small osseous metastasis. There is questionable intrinsic T1 shortening which would favor the former. This could be further evaluated with a bone scan if clinically warranted. Otherwise no definite evidence of metastatic disease within the visualized cervical or thoracic spine. 2.Multilevel degenerative changes involving the cervical and thoracic spine without high-grade spinal canal stenosis at any level. Additional details regarding degenerative findings in the cervical spine as above.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.