History of renal carcinoma and vertebral compression fractures. Thoracic spine: The expansile, lobulated metastatic lesion involving the left side of the T3 vertebra is overall slightly smaller, with almost complete resolution of the mass-effect on the thecal sac. In the axial plane, the mass along with its left paraspinal component measures 5.7 cm x 5.4 cm compared to 6.7 cm x 6.0 cm, previously. Obliteration of the left T2-T3 and T3-T4 neural foramina persists. The T7-L3 posterior fixation hardware, which is composed of bilateral transpedicular screws at T7, T8, T11, T12, L2 and L3 and dual posterior rods remain grossly unchanged. The metastatic, expansile lesion involving T9 and the smaller T10 vertebral body lesion are also improved with almost complete resolution of the mass-effect on the thecal sac at T9. The mild right T9 vertebral body compression fracture is unchanged or minimally increased. Vertebral body heights across the fused segment also remain preserved. The thoracic spinal cord shows normal signal and shape.Lumbar spine: There is an expandible cage in the right corpectomy defect at L1. Epidural extension of tumor at this level has virtually resolved. There is no significant change in a subcentimeter enhancing lesion in the inferior L5 vertebral body. There is no significant spinal canal stenosis at any of the lumbar spine levels. The L2 through L5 vertebral body heights are preserved. The metastatic, expansile lesions involving the right sacral ala are slightly smaller with less impingement on the epidural fat and nerve sleeves of the right first and second sacral nerves. Another lesion involving the left iliac crest is better defined and perhaps slightly larger and now contains foci of central T2-hyperintensity and peripheral T2-hypointensity. There are changes of previous left nephrectomy. The right adrenal mass is not completely imaged, while the left adrenal mass is not significantly changed in size, but shows central T2-hyperintensity, which may reflect necrosis.
1.The expansile metastatic lesions at T3 and T9 are overall smaller with almost complete resolution of the mass-effect on thecal sac. Also, the smaller T10 vertebral body lesion has regressed since January 2016. Mild right sided T9 vertebral body compression fracture is unchanged or minimally increased.2.The minimally expanded metastatic lesion at L1 vertebral body is slightly improved, with no significant impingement upon the lumbar spinal canal.3.A metastatic lesion involving the right sacral ala is also slightly smaller, with less impingement on the sacral neural foramina, while the left iliac crest metastatic lesion appears to be slightly larger, but may also feature treatment effects. 4.The left adrenal mass now demonstrates necrosis, while the right adrenal lesion is not completely imaged.