Female, 84 years old, with history of breast cancer, presenting with confusion and change of motor function. Brain:Patchy periventricular T2 hyperintense lesions are seen in both cerebral hemispheres. Also noted is mild T2 hyperintensity within the right subinsular region.No evidence of restricted diffusion, parenchymal edema or significant parenchymal mass effect is detected. No abnormal extra-axial fluid collection or evidence of intracranial hemorrhage is seen. The ventricles and sulci are diffusely and symmetrically prominent likely indicating underlying parenchymal volume loss.Lumbar spine:Grade 1 anterolisthesis of L3 relative to L4 and L4 relative to L5 is observed. Vertebral body height and morphology are within normal limits. Degenerative endplate irregularity and signal change is seen but no definite worrisome marrow replacement or evidence of marrow edema is detected. Visualized distal spinal cord, conus and cauda equina are unremarkable except as discussed by level below.No worrisome intraspinal enhancement is detected. No significant or concerning marrow space lesions are seen. Patchy degenerative endplate enhancement is noted, along with inflammatory enhancement along the degenerated lower facet joints. In addition, a 10 mm enhancing lesion within the right lateral aspect of the L4 vertebral body is nonspecific.The discs of the lumbar spine demonstrate diffuse loss of T2 signal. In addition, there is substantial loss of disc height at L4-5 and L5-S1. Additional level specific findings are as follows:L1-2: Facet hypertrophy and ligamentum flavum thickening. Bulging disc asymmetric to the right. Mild generalized spinal canal narrowing. Moderate bilateral foraminal narrowing. L2-3: Facet hypertrophy and ligamentum flavum thickening. Bulging disc. Moderate generalized spinal canal narrowing. Moderate bilateral foraminal narrowing. L3-4: Marked facet hypertrophy and ligamentum flavum thickening. Bulging disc. Moderate to severe generalized spinal canal stenosis with near complete exclusion of CSF and slight crowding of the cauda equina. Moderate left and mild right foraminal narrowing. L4-5: Marked facet hypertrophy and ligamentum flavum thickening. Bulging disc. Moderate generalized spinal canal narrowing with particular effacement of the right lateral recess. Moderate bilateral foraminal narrowing. L5-S1: Facet hypertrophy and ligamentum flavum thickening. Bulging disc with a small left paracentral annular fissure. No significant spinal canal narrowing. Moderate bilateral foraminal narrowing.
1.Within the limitations of a noncontrast examination, no definite evidence of intracranial metastatic disease is seen.2.No definite acute intracranial abnormalities are detected. Scattered white matter lesions are nonspecific but statistically most likely represent chronic microvascular ischemic disease.3.Multilevel degenerative findings in the lumbar spine resulting in fairly significant spinal canal narrowing at L3-4 and L4-5, as well as scattered foraminal narrowing as above.4.No definite evidence of metastatic disease is seen in the lumbar spine. A nonspecific enhancing lesion within the right lateral aspect of the L4 vertebral body is nonspecific. If clinical concern warrants, follow-up imaging can be considered.