Male, 65 years old, with history of metastatic lumbar spine tumor burden with radiculopathy. Thoracic:Numerous foci of T1/T2 hypointensity are seen throughout the thoracic spine. Many of these lesions are surrounded by a rim of STIR hyperintensity. Vertebral body heights are generally well preserved with only slight anterior wedging at some levels most notably T6. Comparison with prior CT examinations is limited, though the number and size of lesions has progressed over the prior two years.At no level does there appear to be gross epidural extension. The spinal canal is not significantly narrowed at any level. The left T2-3 neural foramen is mildly compromised due to some extraosseous tumor extension. Elsewhere, the foramina are patent. The spinal cord shows normal signal intensity and morphology throughout.Multiple hepatic masses are partially visualized.Lumbar:Numerous T1/T2 hypointense lesions are seen involving every vertebral level. As above, most lesions demonstrate rim STIR hyperintensity. Significant tumor extension into the ventral and left lateral epidural space is seen at L5 which causes spinal canal stenosis and crowding of the cauda equina nerve roots. Minimal ventral epidural tumor extension is seen at L4. As above, comparison with prior CT examinations demonstrates interval increase in lesion size and number over the prior two years. It does appear that epidural tumor at L5 has progressed when compared to examinations from earlier this year.The visualized distal spinal cord and conus are unremarkable.. The nerve roots of the cauda equina are within normal limits except as discussed above.A renal cystic lesion is seen on the left.From L1-2 through L3-4, the intervertebral discs are relatively well preserved with no significant spinal canal or foraminal compromise.At L4-5, facet arthropathy, disc bulging, and epidural tumor contribute to a significant spinal canal narrowing, particularly below the disc level. The neural foramina are mildly narrowed.At L5-S1, facet arthropathy and disc bulging contribute to mild spinal canal narrowing. The left neural foramen is significantly narrowed due to tumor involvement and degenerative change. The right neural foramen is moderately narrowed due to degenerative change.
1.Numerous sclerotic metastases are evident throughout the thoracic and lumbar spine. Lesions have increased in size and number when comparison is made to multiple prior CT examinations dating back to 2014.2.No significant epidural tumor is seen in the thoracic region. However, epidural tumor is present at the L5 level, progressed from earlier this year, which causes a significant narrowing of the spinal canal and crowding of the cauda equina. Minimal epidural extension is also seen at L4. These findings were discussed with Dr. Reed at 4:20 PM on 11/11/16.