Diagnosis: Malignant neoplasm of prostate. Malignant neoplasm of prostateClinical question: eval for progression of lytic metastasisSigns and Symptoms: prostate cancer with L1 metastasis Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment. The conus medullaris on sagittal imaging is grossly intact. Please note that there is a transitional vertebra present with partial lumbarization of the S1 segment.There is a marrow replacing lesion present at L1 associated with the compression fracture and convex posterior bowing of the posterior wall of the L1 vertebra into the spinal canal. Compared to the 6/5/2015 exam there is no significant change. There is approximately 20% loss of vertebral body height at L1.At S1-S2 there is a formed disc present as well as left-sided facet hypertrophyAt L5-S1 there is a diffuse disc bulge present associated with bilateral facet hypertrophy. The facet hypertrophy is worse on the left compared to the right side. There is partial effacement of the fat at the left lateral recess at this level with some encroachment of the nerve roots at the left lateral recess. There is some mild encroachment of the nerve roots within the left neural foramen at this level with some partial effacement of fat surrounding the left-sided exiting nerve root. There is loss of disc space height and disc desiccation at this level.At L4-5 there is loss of disc space height present as well as disc desiccation and a mild disc bulge associated with bilateral facet and ligamentum flavum hypertrophy. There is some effacement of the fat at the lateral recess bilaterally but slightly more on the right side when compared to the left. There is narrowing of the neural foramina bilaterally.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is some disc desiccation present at this levelAt L2-3 there is no significant compromise to spinal canal or neural foramina. There is disc desiccation present at this levelAt L1-2 there is no significant compromise to spinal canal or neural foramina.The left kidney is not readily identified. There is a retroperitoneal nodule which is not imaged on this exam.
1.Please note the enumeration vertebral bodies. S1 is a transitional vertebra.2.There is redemonstration of a malignant compression fracture at L1 which is stable compared to the prior exam.3.Status post left nephrectomy.4.There are multilevel degenerative changes present in the lumbar spine which are worse at L5-S1 where there is encroachment of the nerve roots of the left neural foramen and the left lateral recess.5.A retroperitoneal nodule suspected represent a benign adrenal gland nodule is not well imaged on this exam. There is a CT of the abdomen from 10/9/2015 which showed assesses this further. Please refer to that report for further comments.