81 yo w known T8-9 vertebral lesion involving spinal canal s/p palliative XRT. Please eval for extent of disease for consideration of surgical debulking. Abdominal pain, back pain, mild lower extremity weakness. PET/CT 12/4/2015, CT chest 11/20/2015 There is an expansile enhancing mass involving the T8 vertebral body and posterior elements with diffuse low T1 signal and increased STIR signal. Mild endplate deformities of the T8 vertebral body are seen. There is mild right and moderate left compression deformity. The tumor extends into the epidural space diffusely, surrounding the spinal cord and causing severe spinal stenosis. There is no definite abnormal cord signal. The epidural component of the lesion extends from T7 to T9 levels. Additionally, there is involvement of the superior endplate of the T9 vertebral body with small area of enhancement. Tumor extension into the neural foramina results in severe bilateral foraminal stenosis at T8-T9, as well as severe left and moderate to severe right neuroforaminal stenosis at T7-T8. There is extension in the costovertebral junctions bilaterally at T8, with poor visualization of the left T8 proximal rib.The left anterior aspect of the T3 vertebral body demonstrates mild enhancement without additional corresponding signal abnormality.There is an approximately 5 cm right upper lobe mass, partially visualized.
1. There is an expansile T8 holovertebral metastatic lesion with diffuse epidural extension between the T7 and T9 levels, with severe central spinal canal stenosis. No definite abnormal cord signal at this time. Up to moderate associated compression deformity.2. Tumor extension into the neural foramina results in severe bilateral neuroforaminal stenosis at T8-T9, as well as severe left and moderate to severe right foraminal stenosis at T7-T8. 3. Likely additional metastatic involvement of the superior T9 endplate.4. The left anterior aspect of the T3 vertebral body demonstrates mild enhancement without additional corresponding signal abnormality. Continued close follow-up is recommended.5. Partially visualized right lung mass.