Newly diagnosed metastatic lung cancer. Evaluate T10 lesion, ?cord compression. Evaluate for other brain/spine mets. Limited noncontrast study. BRAIN: Evaluation for small intracranial metastases is limited on this noncontrast study. No discrete intracranial mass or mass effect is appreciated. There are scattered punctate foci and confluent areas of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter and pons, which are nonspecific but likely representing chronic small vessel ischemic disease. There is focus of susceptibility effect at the inferior aspect of the right temporo-occipital lobe junction likely related to chronic hemorrhage. No evidence of acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable. The patient is status post remote bilateral enucleation with a right eye prosthesis noted. There is fluid level in the bilateral maxillary sinuses. There is a 6 mm T2 hyperintense lesion at the left medial canthus of uncertain etiology.CERVICAL SPINE: No metastatic lesion is definitively appreciated although postcontrast sequences would be helpful. There is mild straightening of the normal cervical lordosis. The vertebral body heights are well-maintained. There is mild to moderate loss of disc height involving the C4-C5 and C5-C6 levels with disc desiccation throughout the cervical spine. The spinal cord is of normal caliber and signal. C2-C3: No significant disc bulge, spinal canal or foraminal stenosis.C3-C4: Posterior disc osteophyte complex with central disc protrusion, thickening of the ligamentum flavum and bilateral facet degeneration, contributing to moderate spinal canal and mild to moderate bilateral foraminal stenosis.C4-C5: Mild posterior disc osteophyte complex, thickening of the ligamentum flavum and bilateral facet degeneration, contributing to mild to moderate spinal canal stenosis and mild to moderate bilateral foraminal stenosis.C5-C6: Posterior disc osteophyte complex, left uncinate hypertrophy, thickening of the ligamentum flavum and bilateral facet degeneration, contributing to mild to moderate spinal canal stenosis and mild right and moderate left foraminal stenosis. C6-C7: Posterior disc osteophyte complex. No significant spinal canal or foraminal stenosis. C7-T1: No significant disc bulge, spinal canal or foraminal stenosis. THORACIC SPINE: There is evidence of metastatic disease with multiple foci of abnormal marrow signal including: posterior aspect of the left T9 vertebral body without retropulsion; expansile lesion involving the right aspect of the T10 vertebral body and posterior elements extending into the right posterior 10th rib, contributing to mild foraminal stenosis at the right T9-T10, moderate foraminal stenosis at T10-T11 and mild spinal canal stenosis at the T10 level; at least 3 small lesions within the T11 vertebral body, one of which is in the right pedicle; and a lesion at the left anterior aspect of the T12 vertebral body. The vertebral body heights are maintained without evidence of pathologic fracture. The spinal cord is of normal caliber and signal.There is no significant disc bulge, spinal canal or foraminal stenosis within the other levels of the thoracic spine. The thoracic spine is in normal alignment, with a normal thoracic kyphosis. LUMBAR SPINE: The lumbar spine is in normal alignment, with a normal lumbar lordosis. There is abnormal marrow signal including: the posterior superior aspect of the L2 vertebral body and left pedicle with mild retropulsion, mild compression deformity and minimal left L1-L2 foraminal narrowing; superior endplate of L3; body of L4 and body and left pedicle of L5. Small lesions within the pelvis are also noted. The distal spinal cord and conus are within normal limits with the conus terminating at the L2 level.There is mild loss of disc height and disc desiccation of the lumbar spine with multilevel degenerative changes including mild disc bulges, thickening of the ligamentum flavum and facet arthropathy, but no significant spinal canal or foraminal stenosis within the other levels of the lumbar spine. OTHER: The partially imaged lungs demonstrate trace right and mild left pleural effusions, left lung mass, multiple bilateral pulmonary nodules, left hilar mass or lymphadenopathy and emphysematous changes. There is partially imaged pericardial effusion. There is nodular thickening of the partially imaged adrenal glands.
1. Noncontrast study limits evaluation for small intracranial metastases. Scattered punctate and confluent areas of abnormal T2 signal within the periventricular and subcortical white matter are nonspecific but compatible with chronic small vessel ischemic disease. No discrete intracranial mass or mass effect is appreciated. Postcontrast imaging can be obtained for more sensitive evaluation if clinically indicated. Focus of chronic hemorrhage at the right temporo-occipital lobe junction noted and nonspecific in etiology.2. Multiple foci of metastatic disease involving the axial skeleton as detailed above, most prominently involving the T10 vertebra and right posterior rib, contributing to mild foraminal stenosis at the right T9-T10, moderate foraminal stenosis at T10-T11 and mild spinal canal narrowing. No evidence of frank cord compression or cord signal abnormality.3. Pathologic compression fracture of the L2 vertebra with mild retropulsion but without significant spinal canal stenosis.4. Multilevel degenerative changes of the cervical and lumbar spine, most prominent at C3-C4 through C5-C6, contributing up to moderate spinal canal stenosis and variable multilevel foraminal stenosis as described.5. Partially imaged left lung mass, bilateral pulmonary nodules, left hilar mass or lymphadenopathy and emphysematous changes. Please refer to the separate chest, abdomen and pelvis CT report for additional details.6. Bilateral globe enucleation. A 6 mm T2 hyperintense lesion at the left medial canthus of uncertain etiology. Please correlate with physical exam.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.