Male, 62 years old, with prostate cancer and lower extremity weakness with low back pain. Evaluate for compression. Evidence of kyphoplasty is again seen at the L1 and L2 vertebral bodies. The L1 vertebral body is significantly wedged, particularly anteriorly where there is about 60% loss of vertebral body height. Significant central compression of the L2 vertebral body is also seen. These findings are relatively similar to those noted on prior CTs, but are new or progressed when compared to the older MRI exam.Findings at T12 are discussed on the recent thoracic spine MRI. Areas of marrow replacement are demonstrated within L1 and L2, surrounding the kyphoplasty cement, as well as within the left pedicle of L3, the vertebral bodies of L4 and L5, and numerous spinous processes. The sacrum is also extensively involved with metastatic disease. A bulky tumor deposit at the S3 level on the right projects into the presacral space anteriorly and infiltrates the right S1 and S2 neural foramina. Furthermore, the right sacral ala is extremely irregular with areas of sclerosis and potentially fragmentation or pathologic fracturing.Beginning at the L3 level and continuing down into the sacrum, there is a loculated, heterogeneous epidural collection which is predominantly dorsal but also wraps to the ventral aspect in some places. This collection is of low signal intensity on T1-weighted images but is heterogeneous on T2 and shows thin peripheral enhancement. The collection contributes to a severe long segment spinal canal stenosis from L3 through the sacrum with likely compression of the cauda equina nerve roots.T12-L1: Retropulsed vertebral body material and focal kyphosis results in a moderate generalized spinal canal stenosis. The neural foramina are moderately narrowed as well.L1-2: Facet hypertrophy and ligamentum flavum thickening. Bulging disc preferentially towards the neural foramina. No significant spinal canal stenosis, though there does appear to be some clumping of the nerve roots in this area. Mild bilateral foraminal narrowing. L2-3: Facet hypertrophy and ligamentum flavum thickening. Bulging disc. Epidural collection, predominantly ventrally. Severe spinal canal narrowing with compression of the cauda equina. Severe right and moderate left foraminal narrowing. L3-4: Facet hypertrophy and ligamentum flavum thickening. Bulging disc. Epidural collection, predominantly dorsally. Severe spinal canal narrowing with compression of the cauda equina. Severe left and moderate right foraminal narrowing. L4-5: Facet hypertrophy and ligamentum flavum thickening. Bulging disc with a small central protrusion. Epidural collection predominantly dorsally. Severe spinal canal narrowing with compression of the cauda equina. Severe right and moderate left foraminal narrowing. L5-S1: Facet hypertrophy and ligamentum flavum thickening. Epidural collection predominantly dorsally. Effacement of the spinal canal with perhaps some nerve root compression. Moderate bilateral foraminal narrowing.
Findings are seen compatible with progression of osseous metastatic disease when comparison is made to the prior MRI examination.Sequelae of prior kyphoplasty are seen at L1 and L2. Compression deformities of the T12-L2 vertebral bodies are also seen, progressed from prior MRI exams but similar to that noted on more recent CTs.Severe metastatic involvement of the right aspect of the sacrum is seen with a large exophytic tumor deposit projecting into the right presacral space with infiltration of the right S1 and S2 neural foramina. The right sacral ala is extremely irregular and likely fragmented or pathologically fractured.A long segment, loculated and heterogeneous epidural collection is seen beginning at approximately L3 and continuing down into the sacrum. This results in severe spinal canal narrowing with compression of the nerve roots of cauda equina. This is new when compared to the prior MRI examination. The etiology of the collection is uncertain but it does appear to resemble fluid rather than epidural tumor. As such, this may represent an evolving epidural hematoma, loculated effusion or abscess in the appropriate clinical context.Findings were discussed with Dr. Jacobs at 4:30 PM on 12/1/15.