Clinical question: New onset of back pain in patient with metastatic melanoma. Please evaluate. Signs and symptoms: Back pain. Pre and post enhanced thoracic MRI:There is normal anatomical alignment of vertebral column however with mild exaggeration of thoracic kyphosis likely secondary to degenerative disease.Mild to moderate degenerative disease with loss of intervertebral disc height throughout the mid to lower thoracic spine is noted.There is a tiny focus of T2 STIR hyperintensity with very faint enhancement in the superior T12 vertebral body and without convincing signal abnormality on T1-weighted images. Remote possibility of a metastatic lesion cannot be entirely excluded.Otherwise there is no definitive focus of signal abnormality or enhancement to suggest metastatic disease of the vertebral column. There is normal signal intensity and caliber of thoracic cord and without detectable abnormal enhancement of the cord or the leptomeninges.There is no evidence of a spinal stenosis and no significant neural foraminal compromise at any level is identified.No evidence of perispinal soft tissue abnormality. Pre and post enhanced lumbar MRI:The anatomical alignment of vertebral column is normal.There is an approximately 11 mm focus of T1 hyperintense, T2 and T2 STIR hyperintense in the vertebral body of L1 with faint enhancement. This examination also redemonstrate a tiny focus of enhancement in the vertebral body of T12 measuring 9 mm size as mentioned above.The signal intensity in the alignment of vertebral column is otherwise unremarkable.The signal intensity of the lower most visualized thoracic cord, conus and cauda equina is also within normal and without detectable abnormal enhancement.There is mild degenerative changes of the discs and mild to moderate hypertrophic changes of posterior elements without spinal stenosis.Left facet effusion at L2-L3, L3-L4 and bilaterally at L4-L5 levels are noted.No detectable. Spinal soft tissue abnormalities.
1.Pre and post enhanced MRI of thoracic spine demonstrate a tiny focus of enhancement in the superior T12 vertebral body which is a nonspecific finding however possibility of a tiny metastatic lesion cannot be entirely excluded. Unremarkable pre and post enhanced exam otherwise for metastatic disease, spinal canal or neural foraminal compromise. Normal signal intensity and caliber of the cord without abnormal enhancement. 2.Pre- and post enhanced lumbar MRI demonstrate an 11 mm faint focus of enhancement in the inferior body of L1 which is a nonspecific finding however possibility of a metastatic lesion cannot be entirely excluded. Unremarkable pre and post enhanced MRI of lumbar spine otherwise without detectable abnormal enhancement of the vertebral column, lower most visualized thoracic cord, conus or the cauda equina. No spinal stenosis or neural foraminal compromise. Degenerative changes and mild facet effusion as detailed above.3.Neither one of the small lesions in vertebral bodies of T12 and L1 are detected on CT of abdomen performed on 7-1-15.