 The exam is mildly limited due to motion artifact.CERVICAL: There is minimal loss of height of C4, C5 and C6 vertebral bodies which is suspected to be developmental/degenerative. The osseous marrow signal is benign. There are multiple intracranial metastases partly imaged, similar to prior MRI of the brain. There is increased T2 signal within the cervical cord extending from C6-7 level to the lower aspect of T3 level with expansion of the cord, and enhancement predominantly in the right hemicord, extending to the posterior and lateral intradural space as well with suspected involvement of the posterior dura. There appears to be a small area of intervening normal cord signal and lack of enhancement between the more confluent areas of abnormality. Due to expansile cord, there is partial effacement of the CSF with at least mild to moderate central spinal canal stenosis at the C6-7 level predominantly.C2-3: Tiny disk osteophyte complex with no spinal stenosis.C3-4: Disk osteophyte complex with no significant spinal stenosis and mild effacement of ventral CSF. Mild bilateral uncovertebral hypertrophy causing minimal bilateral neural foraminal narrowing.C4-5: Disk osteophyte complex with bilateral uncovertebral hypertrophy with no spinal stenosis.C5-6: Disk osteophyte complex with no spinal stenosis.C6-7: Disk osteophyte complex with no spinal stenosis.C7-T1: Disk osteophyte complex with mild protrusion causing mild flattening of the ventral aspect of the cord without cord signal abnormality.There is mild right mastoid fluid.THORACIC: There is normal alignment of the thoracic spine with no significant osseous marrow lesion or signal abnormality/enhancement. There are scattered tiny hemangiomas in the vertebral bodies. The cord caliber and signal are within normal limits below the T3 vertebral level without suspicious enhancement. There is mild enhancement and root thickening of the cauda equina, left greater than right, with adjacent enhancing vessels.There is prominence of posterior epidural fat contributing to minimal diffuse narrowing without significant spinal canal stenosis in the thoracic spine. There is no significant disk herniation or significant spinal canal stenosis in thoracic spine. There is a large right lung mass measuring 34 x 40 mm consistent with known malignancy which apparently extends to the right lateral pleural surface. There are bilateral renal cysts. There is an indeterminate right adrenal nodule measuring approximately 18 x 15 mm.
1.Enhancing intramedullary lesion extending from C6-7 inferiorly to T3 level, predominantly right-sided and extending posteriorly to involve the posterior intradural space and dura is strongly worrisome for metastasis given other lesions in the brain. No other discrete cord lesions.2.At least mild to moderate spinal canal stenosis due to expansion of the cord at the C6-7.3.No definite osseous metastasis.4.There is mild enhancement and root thickening of the cauda equina, left greater than right, with adjacent vessels. This is suspected to be possibly related to metastatic leptomeningeal disease. This can be further evaluated on MRI lumbar spine if clinically indicated.5.Large right lung mass consistent with known primary malignancy.6.Incompletely evaluate right adrenal mass, concerning for metastatic disease, which can be further assessed on dedicated abdominal MRI as clinically indicated.