Metastatic breast cancer, evaluate for leptomeningeal metastasis in lumbosacral spine/cauda equina. Five lumbar type vertebral bodies are presumed to be present. There is evidence of diffuse osseous metastatic disease with particular areas of low T1 signal and marrow replacement identified involving the T12, L1, L5, S1, S2, and S3 vertebral levels. Areas of sclerosis are seen involving the T12 and L1 vertebral bodies in the recent chest/upper abdominal CT studies. There is mild loss of height involving the T12 (also seen on prior CT) as well as the L5 vertebral bodies consistent with pathologic fracture. There is mild anterolisthesis of L4 on L5.There is evidence of epidural tumor extending from L4-L5 to the S3 levels. Axial images are severely motion degraded. There appears to be up to moderate spinal canal stenosis related to the epidural tumor from L5 to the S3 levels.Individual levels as below: T12-L1: No significant spinal canal stenosis. Sagittal images demonstrate mild to moderate right and minimal left neural neural foramina narrowing related to tumor involving the posterior elements at T12 extending into the neural foramina.L1-L2: No spinal canal or neural foraminal stenosis.L2-L3: No spinal canal or neural foraminal stenosis.L3-L4: No spinal canal or neural foraminal stenosis.L4-L5: There is moderate spinal canal stenosis related to mild anterolisthesis, disk bulge, ligamentum flavum thickening, and facet arthropathy. There is minimal component of epidural tumor contributing to stenosis at the inferior aspect of this level. No significant neural foraminal stenosis. Advanced facet arthropathy.L5-S1: There is a right central and paracentral disk protrusion which effaces the lateral recess. There is also facet arthropathy and ligamentum flavum thickening. Degenerative changes and epidural tumor result in mild to moderate central spinal canal narrowing. There is also moderate bilateral neural foraminal stenosis, worse on the right than the left related to combination of degenerative disease and epidural tumor. Moderate facet arthropathy.Motion degradation limits evaluation. However there is extensive tumor infiltration involving the sacrum and iliac bones worse on the right than the left. There is mild encroachment into the bilateral S1-S2 neural foramina.
1. There is evidence of diffuse osseous metastatic disease involving the lumbar spine, visualized lower thoracic spine, and pelvis. There is relatively greater involvement from the L5 to S3 levels with epidural tumor as described above resulting in up to moderate spinal canal stenosis. Epidural tumor in the spinal canal appears relatively worst at the S2 level near the expected level of the termination of the thecal sac. Abnormal enhancement within the lumbosacral spinal canal appears mostly if not all epidural. Severe motion degradation on the axial images significantly limits evaluation however, no definite evidence of leptomeningeal disease is demonstrated.2. Moderate narrowing of the L5-S1 neural foramina related to epidural tumor and to a lesser degree the S1-S2, and T12-L1 neural foramina. 3. Moderate spinal canal stenosis at L4-L5 which appears predominantly on a degenerative basis. Advanced facet arthropathy and grade 1 anterolisthesis noted at this level. 4. Mild pathologic compression fractures at T12 and L5. 