Female, 70 years old, with metastatic breast cancer to the lungs, presenting with pain in the neck up into the bottom of the skull. Assess for metastatic disease. Extensive metastatic infiltration of the C3 and C4 vertebral bodies and posterior elements is noted with minimal infiltration of C5. Extraosseous extension is also seen into the left lateral paraspinal soft tissues.The affected vertebral bodies are mildly expanded and along with nearly circumferential involvement of the neural arch, there is a resulting severe spinal canal stenosis with cord impingement but no definite cord signal abnormality. Tumor extensively infiltrates the left C2-3, C3-4 and C4-5 neural foramina. The left vertebral artery is encased by tumor but the flow void appears to be preserved throughout indicating patency.Elsewhere, the vertebral bodies demonstrate normal signal characteristics and pattern of enhancement. Spinal alignment is straightened. Vertebral body heights are grossly preserved, even those affected by metastatic disease.C2-3: Posterior disc-osteophyte complex formation with a superimposed right paraspinal osteophyte or disc protrusion causing minimal impingement upon the spinal cord. At the disc space, only a mild generalized spinal canal stenosis is seen, though below the disc space, canal stenosis related to metastatic disease begins and is severe. No significant right foraminal narrowing. Tumor infiltration of the left neural foramen is seen. C3-4: Severe spinal canal stenosis and cord impingement secondary to a combination of circumferential tumor with osseous expansion and superimposed degenerative disc disease. The left neural foramen is extensively tumor infiltrated. The right neural foramen is moderately narrowed by degenerative disease. C4-5: Moderate spinal canal stenosis due to a combination of expansile tumor and some superimposed disc degeneration. The cord is impinged to a mild degree. The left neural foramen is tumor infiltrated. The right neural foramen is mildly narrowed by degenerative disease. C5-6: Posterior disc-osteophyte complex formation. Effacement of the ventral thecal sac with a mild generalized spinal canal stenosis but no significant cord deformation. Moderate to severe bilateral foraminal narrowing. C6-7: Minimal posterior disc-osteophyte complex formation. No significant generalized spinal canal or foraminal stenosis. C7-T1: Left facet hypertrophy. Minimal posterior disc-osteophyte complex formation. No significant spinal canal or neuroforaminal stenosis. Left supraclavicular adenopathy is partially imaged on this examination. Abnormal signal within the posterior sphenoid bone extending to involve the clivus may simply represent chronic sphenoid sinus mucosal thickening or a mucous retention cyst, but it is nonspecific.
1.Extensive tumor infiltration is seen affecting the C3 and C4 vertebral bodies and posterior elements, and to a lesser degree the C5 vertebral body. There is substantial left lateral extraosseous tumor spread as well which engulfs the left vertebral artery. 2.The above findings result in a severe stenosis of the spinal canal at the C3 and C4 levels with cord impingement, as well as tumor infiltration of the left-sided neural foramina from C2 through C5.3.Relatively mild degeneration of the disks and posterior elements is seen at the remaining cervical levels.4.Signal abnormality within the posterior sphenoid bone and clivus, partially imaged on this examination, is nonspecific. Dedicated imaging of the head, at least by CT, would likely help to clarify the nature of this finding.