Bilateral lower extremity and upper weakness, known metastasis in the thoracic spine CERVICAL: There is evidence of diffuse osseous metastatic disease throughout the cervical spine affecting all levels and grossly similar in distribution to prior studies. Vertebral body heights in the cervical spine are grossly maintained. There is loss of cervical lordosis. There is abnormal enhancement involving the right ventral epidural space at the C4-C5 level suspected to represent small amount of epidural tumor. There is effacement of the ventral thecal sac at this level without evidence of cord compression. No signal abnormality is seen in the cervical cord. Mild multilevel degenerative changes are present without high-grade spinal canal or neural foraminal stenosis at any level.LUMBAR:Numbering is performed as per prior studies with 5 lumbar type vertebral bodies and a sixth transitional segment labeled S1 for the purposes of this study.There is diffuse osseous metastases throughout the lumbar spine, pelvis, visualized chest wall. There is minimal loss of height involving the L1 vertebral body and relatively greater loss involving the T11 vertebral body. Vertebral body heights in the lumbar spine are otherwise grossly preserved. Alignment in the lumbar spine is grossly preserved. There is no evidence of spinal canal stenosis at any level in the lumbar spine. There is T2 hyperintensity within the distal cord related to intramedullary metastasis at the T12-L1 level as seen on recent thoracic spine study. There is associated enhancement which extends to the ventral leptomeningeal surface of the cord.There is no definitive evidence of epidural tumor in the lumbar spinal canal within the limitations of the artifact. There is no significant spinal canal stenosis in the lumbar spine at any level. There is bilateral paraspinous tumor centered at the L1 level left greater than right. Tumor is suspected in the neural foramina at the right L1-2 and right L2-L3 level. There is mild neural foraminal narrowing at the right L5-S1 level which may be related to disc disease versus small amount of epidural tumor but is not well assessed due to artifacts.Right-sided hydronephrosis and retroperitoneal lymphadenopathy again noted and better imaged on prior abdominal CT.
1. Diffuse osseous metastatic disease affecting all levels in the cervical and lumbar spine. Mild pathologic compression fractures including the T11 level and to a lesser degree at the L1 level. No associated osseous retropulsion. 2. Thin epidural tumor is suspected in the cervical spine at the right C4-C5 level without mass effect on the cord. No significant spinal canal stenosis is seen in the cervical spine or lumbar spine.3. Intramedullary metastasis involving the distal cord at the T12-L1 level again seen with enhancement extending to the leptomeningeal surface. 4. There appears to be small amount of tumor involving the neural foramina such as a the right L1-L2 and right L2-L3 levels which is not well evaluated due to artifact. Tumor involving the thoracic neural foramina and epidural space better assessed on recent thoracic spine MRI study.5. Right-sided hydronephrosis and retroperitoneal lymphadenopathy again noted.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.