 THORACIC SPINE: The thoracic spine is in normal alignment, with a normal thoracic kyphosis. There is evidence of metastatic disease throughout the thoracic spine with relatively large lesions at T10, T11 and T12 as described below:-There is a well-circumscribed lesion along the posterior aspect of the T10 vertebral body on the right extending to the right pedicle which demonstrates decreased signal on T1-weighted images with corresponding increasing signal on T2-weighted images and marked enhancement. -There is diffuse marrow infiltration at T11 which is increased since prior MRI study on 9/10/2014. Within this process there is a well-circumscribed lesion demonstrating marked enhancement along the posterior aspect of the vertebral body on the left and extending to the left pedicle. There is associated minimal loss of vertebral body height with no evidence of intervertebral disc retropulsion or significant spinal canal stenosis, however this appears worse since the prior study. -There is a small well-circumscribed lesion within the T12 vertebral body posteriorly and to the right which demonstrates decreased T1 and T2 signal intensity with suggestion of subtle enhancement. This small lesion appears slightly larger compared to prior study measuring 7.4 mm in craniocaudal dimension, previously 5.5 mm. At T2 and T3 there are nonspecific T1 hypointense lesions abutting the posterior inferior endplate without enhancement and appear unchanged from prior study. At T11-T12 there is mild narrowing of the thecal sac as well as moderate narrowing of the left neural foramen. There is no abnormal signal within the spinal cord.At T12-L1 there is moderate left neural foraminal narrowing related to facet arthropathy and disc bulge. No significant spinal canal stenosis is noted.There is no significant disk bulge, herniation, spinal canal or foraminal stenosis throughout the remaining thoracic spine. The spinal cord is of normal caliber and signal with no abnormal leptomeningeal, epidural, or intramedullary enhancement.LUMBAR SPINE: The lumbar spine is in grossly normal alignment, with mild levocurvature and mild left lateral L4 on L5 subluxation. There is loss of height involving the left aspect of the L5 vertebral body similar to prior and possibly on a benign basis with no large underlying lesion appreciated. The distal spinal cord and conus are within normal limits with the conus terminating at the T12-L1 level.There is evidence of metastatic disease throughout the lumbar spine with relatively large lesions at L1 and L2 as described below:-There is a well-circumscribed lesion along the anterior aspect of the L1 vertebral body which demonstrates decreased T1 signal with heterogeneous increased signal on T2 as well as heterogeneous enhancement.-A similar lesion affects the L2 vertebral body.-There is extensive signal abnormality involving the lateral aspect of L5 and S1 vertebral bodies on the left.There are advanced degenerative changes seen as described below which overall appear similar to prior study: At L1-L2 there is effacement of the left lateral recess without central canal stenosis. There is moderate left and mild right neural foraminal narrowing.At L2-L3 there is moderate spinal canal stenosis. There is moderate right and mild left neural foraminal narrowing.At L3-L4 there is severe spinal canal stenosis. There is moderate right and mild left neural foraminal narrowing.At L4-L5 there is moderate spinal canal stenosis. There is moderate to severe left and moderate right neural foraminal narrowing.At L5-S1 there is mild spinal canal stenosis including effacement of the lateral recesses. There is moderate right and severe left neural foraminal narrowing. OTHER:There are multiple lesions in the sacrum including a partially imaged left S3 lesion which was present before.There is a well-circumscribed lesion of the right iliac wing with abnormal T1 and T2 signal and demonstrates marked enhancement. This small lesion appears slightly larger compared to prior study, measuring 17 mm in AP dimension, previously 13 mm. There are innumerable enhancing lesions within the partially imaged lungs compatible with metastatic disease which are better evaluated on recent CT study. There are bilateral renal cysts.
1. Multilevel metastatic disease throughout the thoracic and lumbar spine with mild progression as described above. T11 vertebral body lesion again seen with more diffuse marrow signal abnormality and minimal pathologic compression deformity appearing worse from prior study. Mild compression deformity involving the left aspect of the L5 vertebral body appears similar to prior and possibly on a degenerative basis. Otherwise no significant pathologic compression deformities in the thoracic or lumbar spine. No evidence of epidural tumor or leptomeningeal disease.2. Advanced degenerative changes in the lumbar spine with severe spinal canal stenosis at L3-4 and moderate at L2-3 and L4-5. There is also moderate to severe neural foraminal narrowing at multiple levels as detailed above.3. Innumerable pulmonary metastatic disease which is better evaluated on recent CT study. 