Male, 74 years old, with history of lung cancer and new complaint of spinal pain. Cervical:Progressive marrow replacing signal abnormality is seen within the right occipital condyle and adjacent lateral mass of C1, as well as the bilateral C2 laminae and spinous process, with additional areas of marrow replacement in at least the C5 and C7 vertebral bodies. No evidence of pathologic epidural or intrathecal enhancement is seen.Trace retrolisthesis of C4 relative to C5 and C5 relative to C6 are demonstrated. Spinal alignment is otherwise unremarkable. Vertebral body heights are preserved.C2-3: Central disk extrusion without significant generalized spinal canal and neuroforaminal stenosis. No interval changes.C3-4: Left facet hypertrophy. Posterior disk osteophyte slightly asymmetric to the right with perhaps a small central protrusion. No significant generalized spinal canal stenosis. Mild right neuroforaminal narrowing. No interval changes.C4-5: Posterior disk osteophyte complex asymmetric to the left with a superimposed central protrusion. Mild to moderate spinal canal stenosis is seen with minimal ventral cord deformation, not changed from prior. Moderate left and mild right neuroforaminal narrowing. No interval changes.C5-6: Facet hypertrophy. Posterior disk osteophyte complex. Moderate generalized spinal canal stenosis with flattening of ventral cord. Moderate to severe bilateral foraminal narrowing. No interval changes.C6-7: Posterior disk osteophyte complex. No significant spinal canal stenosis. Moderate left and mild right foraminal narrowing. No interval changes.C7-T1: Facet hypertrophy. No significant disk disease, spinal canal or neuroforaminal stenosis. Thoracic:Progression of metastatic disease is again seen with new or larger areas of marrow replacing signal abnormality in most of the thoracic vertebral bodies. This includes essentially complete replacement of the T4 and T6 vertebral body marrow, with significant involvement of T7, T8, T10 and T12 as well. Mild compressions of the T4 through T6 and T12 vertebral bodies are probably not significantly changed.On postcontrast imaging, there is the suggestion of minimal ventral epidural tumor spread at least on the left at T6, and on the right at T8-9. These suspected areas of epidural involvement cause no significant canal stenosis or mass effect on the cord.Significant level specific findings are as follows:T1-2: Small right paracentral disk protrusion. No significant spinal canal stenosis or neuroforaminal narrowing. No interval changes.T2-3: Facet hypertrophy on the left with mild left neuroforaminal narrowing. No interval changes.T7-8: Central disk extrusion without significant spinal canal or neuroforaminal stenosis. No interval changes. T8-9: Central disk extrusion without significant spinal canal or neuroforaminal stenosis. No interval changes. Progressive mediastinal adenopathy is also seen, including a subcarinal mass which measures 30 x 20 mm on the present study which was not detectable on the prior study. Lumbar:Multiple areas of marrow replacing signal abnormality are demonstrated, most conspicuously within the L2 vertebral body and pedicle on the left and within the left aspect of the S1 S1 vertebral body where there are multiple foci on both sides. A lesion is also partially visualized in the right iliac bone. Numerous smaller lesions are also suspected within the remaining vertebral levels and elsewhere in the visualized pelvis. While disease in the L2 vertebral body may not have significantly progressed, disease in the sacrum and small foci scattered throughout remaining levels have clearly progressed.On postcontrast images, no definite evidence of significant epidural disease extension is seen. However, a new subcentimeter nodule of enhancement is evident within the left aspect of the cauda equina at the L2 level, and also probably more inferiorly at the L4-5 level.Spinal alignment is anatomic. Vertebral body heights are preserved. Disk heights are grossly preserved. Facet and ligamentum flavum hypertrophy develop at lower levels becoming quite severe at L5-S1. Disk bulging is seen at L3-4 and L4-5. This results in narrowing of the left lateral recess and moderate bilateral foraminal narrowing at L4-5, but no significant generalized spinal canal stenosis. Small renal cystic lesions are demonstrated in the left.
1. Progression of marrow space metastatic disease as discussed above.2. Minimal epidural tumor extension is suspected in the thoracic spine without significant spinal canal encroachment.3. Two new intradural enhancing nodules are evident along the nerve roots of the cauda equina at the L2 and L4-5 levels concerning for intradural metastases.4. Progressive mediastinal adenopathy.