Female, 55 years old, with history of metastatic breast cancer now with worsening low back pain. Thoracic:Marrow replacement of the T2 vertebral body and pedicles is again seen. Mild progressive extraosseous disease spread is seen along the left anterior paraspinal space. There is mild encroachment of the ventral and lateral epidural spaces at T2, but no significant thecal sac narrowing. The vertebral body otherwise appears similar to prior. No loss of height or retropulsion is seen. Since the prior examination, however, multiple new patchy and nodular areas of marrow replacement are seen in almost every thoracic vertebral body and to a lesser degree the posterior elements. None of these new lesions is associated with any significant epidural disease spread. No retropulsion or loss of vertebral body height is detected.The thoracic spinal canal remains patent throughout. There is no evidence of significant spinal canal stenosis. The left T2-3 and right T3-4 neural foramina are narrowed due to expansile tumor.The visualized spinal cord shows normal signal intensity and morphology. No pathologic intradural enhancement is seen.Lumbar:Again seen is evidence of instrumented posterior fusion of L5 and S1. Posterior element resection has also likely been performed.Since the prior examination, extensive tumor involving the left aspect of the L5 and S1 vertebral bodies appears more heterogeneous and less bulky perhaps representing the effect of therapy. As before, this lesion results in no significant epidural encroachment or spinal canal narrowing.However, as in the thoracic spine, there are numerous new patchy areas of marrow replacement in every lumbar vertebral body level. None of these lesions is associated with significant epidural encroachment. No loss of vertebral body height or retropulsion is seen.No significant degenerative disc disease is seen. The spinal canal and neural foramina remain patent although the L5-S1 foramina which are not well assessed due to artifact.The visualized distal spinal cord, conus and cauda equina show normal signal intensity and morphology. No pathologic intradural enhancement is seen.
1.Slight interval expansion of metastatic tumor involving the T2 vertebral body with mild epidural encroachment but no significant spinal canal stenosis.2.Metastatic disease involving the L5 and S1 vertebral bodies appears somewhat less bulky than on the prior examination which may reflect response to therapy.3.Multiple new metastatic lesions are evident within the marrow space involving nearly every level of the thoracic and lumbar spine. None of these new lesions is associated with any significant epidural encroachment or spinal canal stenosis. No vertebral body compression or retropulsion is seen.