66-Year-old female with left lower extremity weakness and history of spine metastases. Evaluate for spinal cord compression. MRI T-Spine:There is prominent kyphosis involving the thoracic spine with the fulcrum at the T8 level where there is a severe (greater than 75% height loss) compression fracture, probably pathologic, which was seen previously. There is no significant change in the fracture compared to the OSH CT CAP from 5/23/2016. There is mild-moderate narrowing of the spinal canal at this level secondary to mild retropulsion with mild cord T2 signal abnormality which is unchanged compared to the exam from 5/23/2016. The remaining vertebral body and disc space heights are unchanged, including a focal peripherally enhancing lesion with T2 hyperintensity involving the posterosuperior endplate of T11. This corresponds with a lucent lesion with sclerotic margins on prior CT exams and likely represents a metastatic lesion. Redemonstrated is a large left apical lung mass better appreciated and characterized on the prior CT chest. The apical mass approaches the left T2 and T3 vertebral bodies and there is enhancement of these vertebral bodies which could either be reactive or due to subtle invasion by tumor. The left T3-4 neural foramen appears infiltrated by tumor. There is no definite epidural extension of tumor in the upper thoracic spine.MRI L-Spine:For the purpose of numbering, there are 13 thoracic vertebrae and 5 lumbar vertebrae. There is lordotic curvature of the lumbar spine with minimal retrolisthesis of L3 on L4 and minimal anterolisthesis of L4 on L5. The vertebral body heights are preserved. There is multi-level disc dessication and disc height loss involving the lower lumbar spine, most prominently involving the L3-4 and L4-5 levels. There is subtle marrow inhomogeneity with a concavity involving the superoanterior endplate of L5 indicating likely metastatic disease. There is also extensive heterogeneity, enhancement and thickening of the sacrum compatible with sclerotic metastatic disease seen on prior CTs. There is also evidence of metastatic osseous disease involving the iliac bones bilaterally. There is evidence of epidural extension into the spinal canal in the sacral region at the S1-2 level with significant spinal canal compromise. The neural foramina of S1 are significantly infiltrated by tumor bilaterally . The S2 neural foramina are infiltrated to a mild degree.The lumbar spinal cord displays normal signal and morphology and terminates at the L1 level. The right adrenal metastasis is visualized and better characterized on the recent CT abdomen and pelvis. Interspace observations:T12-L1 and L1-2: There is no significant compromise to spinal canal or neural foramina.L2-L3: Mild disc bulge. Mild facet arthropathy. No spinal canal or neuroforaminal stenosis.L3-L4: Right greater than left disc bulge. Mild facet arthropathy and ligamentum flavum thickening. Mild spinal canal stenosis. Mild to moderate right and mild left neuroforaminal narrowing. L4-5: Disc uncovering with a disc bulge. Moderate facet arthropathy and ligamentum flavum thickening. Mild spinal canal stenosis. Mild bilateral neuroforaminal narrowing.L5-S1: Moderate facet arthropathy. No spinal canal or neuroforaminal stenosis.
1.Multiple areas of metastatic involvement in the thoracic and lumbosacral spine, most severely involving the sacrum where there is infiltration of tumor and compromise of the sacral spinal canal at S1-2. There is significant infiltration of the S1 neuroforamina bilaterally by tumor and to a mild degree also involving the S2 neuroforamina. 2.Large left apical lung mass which approaches the left T2 and T3 vertebral bodies and infiltrates the left T3-4 neural foramen . 3.Severe likely pathologic compression fracture (greater than 75% height loss) involving the T8 vertebral body. The severity of the compressed vertebral body, spinal canal narrowing and spinal cord signal abnormality are unchanged compared to the previous exam.4.Right adrenal metastasis is better characterized on the recent CT Abdomen/pelvis from 12/19/2016.5.Additional multilevel degenerative changes in lumbar spine are as described above.