 The exam is limited secondary to susceptibility artifact from surgical hardware. Again seen are postoperative changes of partial corpectomy of T6 and T7 with expandable cage placement and paraspinous rods and transpedicular screws extending from T4 inferiorly to T11 for fusion. Laminectomies are seen from T6 to T8 with decompression of the spinal canal at these levels.There is extensive marrow infiltration involving the thoracic vertebral bodies which has progressed since prior MRI from 9/15/2015. Most notably there is interval increased infiltration involving the T1, T2, T3, and T4 vertebral bodies extending into the posterior elements, left worse in right.There is mild deformity involving the T1 and T2 vertebral bodies with minimal loss of height which is new since 9/15/2015. There is minimal osseous retropulsion of the T2 vertebral body with mild spinal canal stenosis at this level. Osseous retropulsion involving the T7 vertebral body is again noted, with the spinal canal surgically decompressed at this level. Lack of postcontrast sequence limits evaluation for epidural tumor. There is ill-defined low T1 and low T2 signal involving the upper thoracic spinal canal which appears worse and suspected to represent worsening epidural tumor and can be confirmed with postcontrast sequence. No obvious cord signal abnormality.Limited view of the cervical spine on the sagittal counting sequence demonstrates moderate to severe spinal canal stenosis at the C2-C3 level which is not well assessed but appears worse since prior MRI from 9/15/2015.Mediastinal lymphadenopathy again seen.
1. Compared to MRI from 9/15/2015 there is evidence of progression of metastatic disease with increased marrow infiltration particularly of the T1 to T4 vertebral bodies extending into the posterior elements. There appears to be increased epidural tumor at these levels which can be better assessed/confirmed with postcontrast sequence. No new cord signal abnormality within the limitations of susceptibility artifact from the hardware.2. Postsurgical changes related to partial corpectomy of T6 and T7 with cage placement, posterior fusion from T4 to T11, and laminectomies from T6 to T8.3. Mild deformity/compression fractures involving the T1 and T2 vertebral bodies with mild osseous retropulsion involving the T2 vertebral body which is new since prior MRI. There is mild spinal canal stenosis at this level.4. Limited view of the cervical spine on the sagittal counting sequence demonstrates moderate to severe spinal canal stenosis at the C2-C3 level which is not well assessed but appears worse since prior MRI from 9/15/2015. Consider dedicated cervical spine MRI for further evaluation.