Female, 40 years old, history of breast cancer. Assess for metastases to the spine. Admitted with transient altered mental status and seizures. MRI concerning for leptomeningeal enhancement. Cervical:Patchy low T1/T2 signal is evident within the C5 and C7 vertebral bodies. No corresponding marrow edema or pathologic enhancement is detected.Fatty signal intensity anteriorly within the C6 vertebral body is also seen. Elsewhere, no definite concerning marrow replacement is detected. Vertebral body height and morphology are preserved. No epidural disease extension is seen. Alignment is anatomic.The visualized spinal cord shows normal signal intensity and morphology. No evidence of pathologic intramedullary or leptomeningeal enhancement is seen.C2-3: Unremarkable. C3-4: Minimal posterior disc-osteophyte complex formation. No significant spinal canal or foraminal stenosis. C4-5: Minimal posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Mild left foraminal narrowing. C5-6: Minimal posterior disc-osteophyte complex formation. No significant spinal canal or foraminal stenosis. C6-7: Unremarkable. C7-T1: Unremarkable. Thoracic:Patchy T1/T2 hypointense marrow replacement is again seen at numerous levels, most conspicuously involving T4, T8-T10, and T12. The T12 vertebral body is completely infiltrated and there is mild anterior wedging with minimal retropulsion. Speckled fatty signal is also seen scattered throughout some of these lesions and in the T11 vertebral body. Mild patchy enhancement is also seen in association with these lesions. No evidence of any significant epidural disease extension is seen.The visualized spinal cord demonstrates normal signal intensity and morphology. Postcontrast images are degraded by motion, but no definite evidence of any intramedullary or leptomeningeal enhancement is seen.A mild scoliotic curvature of the thoracic spine is demonstrated. In addition, there is a mild focal kyphotic angulation of the spine centered at T11 and T12. Otherwise, the vertebral bodies are well aligned in the sagittal plane.Scattered small disc protrusions are evident at T7-8 and T10-11. No significant spinal canal or neuroforaminal stenosis is seen.Lumbar:Patchy heterogeneous marrow replacement is seen, largely fatty at L1 and L2, but with areas of low T1/T2 signal at L3-L5. These lesions show only minimal evidence of edema and little or no pathologic enhancement. The sacrum, however, is infiltrated with patchy heterogeneous signal which does demonstrate significant associated enhancement.Vertebral body height and morphology are within normal limits. No compression fractures are seen. No significant epidural disease extension is detected. Alignment is anatomic.On postcontrast images, the nerve roots of the cauda equina appear to be diffusely enhancing. No large or nodular tumor deposits are suspected.Minimal degenerative disc disease is seen at L4-5 with loss of T2 signal and very mild disc bulging. Moderate facet hypertrophy develops at lower levels. No significant spinal canal or neuroforaminal stenosis is seen.
1. Findings are seen concerning for leptomeningeal disease involving the cauda equina. No discrete leptomeningeal involvement is suspected at more superior levels, though some images are motion degraded which reduces the sensitivity.2. Fairly diffuse and widespread osseous metastatic disease is seen. Most of these lesions demonstrate a largely T1/T2 hypointense appearance which correlates to sclerotic lesions seen on recent CT. Some of these lesions show intermixed fatty replacement and some mild associated enhancement. The pattern is suggestive of both treated and perhaps minimally active metastatic disease. The most active lesions are suspected to be in the sacrum by virtue of their robust enhancement.3. No evidence of any significant epidural disease extension is seen. No high-grade spinal canal or neuroforaminal stenosis is detected.