Reason: evaluation for thoracic mets History: breast cancer new diagnosis breast cancer MRI thoracic spine:There is diffuse marrow replacement present. Compression fractures are present at multiple levels including T6 were there is 40% loss of vertebral body height, and T8 were there is 40% loss of vertebral body height T11 where there is 25% loss of vertebral body height and L1 where there is 60% loss of vertebral body height. There is extraosseous extension into the spinal canal at L1 and T8 and T6. At L1 there is a mild degree of spinal stenosis, retropulsion of T12 on L1 and encroachment of the exiting nerve roots within the neural foramina.The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots. There are bilateral pleural effusions present.There small enhancing nodules scattered in the peri-vertebral musculature and subcutaneous tissues behind the thoracic spine which could represent metastatic foci. One in the left peri-vertebral musculature at the T9 vertebral level measures 12mm x 5 mm sagittal dimensionsLumbar spine:Compression fracture is present at L1 where there is 60% loss of vertebral body height. There is extraosseous extension into the neural foramina and adjacent spinal canal at L1. There is a mild degree of spinal stenosis and retropulsion of T12 on L1 resulting in encroachment of the exiting nerve roots within the neural foramina.The conus medullaris on sagittal imaging is grossly intact.No abnormal enhancing lesions are appreciated in the lumbar spine.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is facet hypertrophy present at this level. There is marked thickening of the right L5 pedicle as a result of tumor with some extension into the adjacent neural foramina without compromise to the exiting nerve roots.At L4-5 there is no significant compromise to spinal canal or neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.
1.Diffuse osseous metastases throughout the visualized spine with multiple pathologic compression fractures at T6, T8, T11 and L1 but worse at L1. There is a small amount of epidural extension at T6, T8 and L1. There is some subluxation of T12 on L1 with encroachment of the exiting nerve roots within the neural foramina. There is mild spinal stenosis at L1 as a result of the compression fracture and retropulsion with minimal spinal canal narrowing contributed from the at the epidural extension.2.There are a few small scattered subcutaneous and perivertebral musculature nodules present which are suspicious for metastatic involvement.3.There are bilateral pleural effusions present.