Clinical question: 74 year old female with metastatic breast cancer with involvement of prevertebral and paravertebral tissues in the cervical spine. Status post RT. Evaluate for change. Compared to prior exam from 6 -- 15 -- 11. Enhanced CT of soft tissues of neck:40 cc of Omnipaque 350 was given for this study. Multidetector helical CT of entire soft tissues of neck are acquired. Coronal and sagittal 2-D reformatted images are also acquired.Examination demonstrates a soft tissue mass in the right carotid space at the level of the skull base and C1 level. The mass surrounds the right transverse process of C1 and is inseparable from right vertebral artery at C1 level. There are diffuse lytic changes in the C1 vertebrae as well as lateral mass of C2 on the right. There is subtle mass effect and anterior displacement of the right internal carotid artery secondary to tumor. The tumor also reaches the right styloid fragment. The right internal jugular is compressed by the mass however remains patent. When compared with prior exam there is subtle interval decrease in the bulk of the tumor and apparently less mass effect on the carotid. There is no definitive extension of tumor into the spinal canal on this exam. On prior study there was a slight widening of the right epidural space likely secondary to tumor at C1 level. The very irregular shape of tumor makes precise measurement difficult however on axial image 22 at C1 level the extra osseous component of tumor measures 22 x 27.5-mm. And coronal post infused reformatted image 40 cranial cephalad axis of tumor measures 22-mm. A previous reported right-sided lymph node at the level of two also demonstrate interval decrease in its size. This node measures 6.6-mm in size compared to prior measurements of 11.8 times 8.6-mm. Or there is no evidence of any new lymphadenopathy. The vasculature of the neck remains intact. Limited images through the apices of the lungs demonstrate apical scarring and without definitive evidence of metastases. No appreciable interval change since prior exam. Please review dedicated report of CT of chest performed the same date as this study. Possible small metastatic lesions in C5 and C7 best appreciated on sagittal reformatted bone density image 22. These findings were present on prior study. If further evaluation of spine metastatic lesions are desired dedicated pre-and post enhanced MRI of cervical spine is recommended.
1.Interval significant decrease in the size of tumor at C1 and C2 right paraspinal region. Lytic metastatic lesions in C1 and C2 may be the source of this right-sided paraspinal soft tissue mass. Interval necrosis and decrease in the size of right-sided level 2 lymph node. No evidence of new lymphadenopathy.2.Residual tumor at C1 -- C2 level on current exam measures 22 x 27 x 40 mm.3.suspected small intra-osseus lytic metastatic lesions at C5 and C7. Questionable other lytic changes in the cervical spine. If further evaluation is desired dedicated pre-and post enhanced MRI of spine is recommended.