Low back pain with right greater than left radicular symptoms. History of liver cancer with L4 lesion on CT. For the purposes of numbering the most inferior rib-bearing vertebra is labeled T12. There is transitional anatomy with partial sacralization of the L5 vertebral body.There is abnormal T1 hypointensity involving the right lateral aspect of the L3 vertebral body with associated T2/STIR hyperintensity and enhancement, highly suspicious for metastasis. Lesion measures approximately 3.7 x 3.8 x 2.8 cm in the AP, transverse, and craniocaudal dimensions There is minimal involvement of the adjacent right paravertebral soft tissues. Posterior cortex of the vertebral body remains intact. Abnormal signal extending into the posterior elements is favored to represent edema. No evidence of epidural tumor or leptomeningeal disease.There are multiple small Schmorl's nodes throughout the visualized spine. There is mild loss of height involving the L2 vertebral body related to Schmorl's noted as well as a broader depression of the superior endplate compatible with a chronic compression fracture. Mild superior endplate deformity is also evident at the right aspect of the L1 vertebral body. These findings are unchanged since CT from 7/28/2014. No findings to suggest an acute compression fracture. Enhancement involving the superior endplate of L2 is favored to be related to the Schmorl's node. No additional metastatic lesions are definitively appreciated.There is mild developmental narrowing of the lumbar spine with superimposed degenerative changes as described below: L1-L2: Minimal disc bulge, ligamentum flavum thickening, and bilateral facet arthropathy contribute to mild spinal canal narrowing. Neural foramina are patent.L2-L3: Mild disc bulge, facet arthropathy, and ligamentum flavum thickening with associated mild to moderate spinal canal narrowing. Neural foramina are patent.L3-L4: Disc bulge, ligamentum flavum thickening, and advanced facet arthropathy contribute to moderate to severe spinal canal stenosis. There is moderate right and mild to moderate left neural foraminal stenosis.L4-L5: Disc bulge, advanced facet arthropathy, ligamentum flavum thickening contribute to moderate spinal canal stenosis. There is mild to moderate bilateral, left slightly worse than right, neural foraminal stenosis. L5-S1: No significant disc disease. No spinal canal or neural foraminal stenosis. Bilateral facet arthropathy.
1. Enhancing lesion involving the right aspect of the L4 vertebral body is most consistent with metastatic disease and demonstrates enlargement on CT studies from 2/29/2016 and 5/23/2016. No associated epidural tumor or pathologic compression fracture. No additional metastatic lesions are definitively appreciated.2. Advanced degenerative changes in the lumbar spine including moderate to severe L3-L4 and moderate L4-L5 spinal canal stenosis. There is also neural foraminal narrowing at multiple levels as detailed above.