84-year-old male with urothelial cancer, evaluate for progression in L3 lesion which was noted on CT scan. There is normal lordotic curvature of the lumbar spine with progressed now 6 mm of anterolisthesis of L4 on L5 and 3 mm of retrolisthesis of L5 on S1. The vertebral body heights are preserved. There is variable disc height loss most prominent at the L5-S1 level which was present in 2006. There has also been progression of the loss of disc height at the L2-L5 levels, especially at the L4-5 level. There are endplate degenerative changes noted at the L5-S1 level which were present in 2006.The lucent lesion seen in the inferior endplate of L3 on the most recent previous CT abdomen and pelvis demonstrates peripheral and surrounding STIR signal abnormality on the current MRI as well as internal T1/T2 isointense signal relative to the adjacent L3-4 disc. There has been no change in the size of the lesion compared to the CT abdomen and pelvis exam from 12/8/2015. The associated enhancement is felt to be reactive. The lesion was appreciable on the 2014 abdomen and pelvis CT, subtly present on the 2013 abdomen and pelvis CT, and is favored to represent a degenerative Schmorl's node rather than a metastatic lesion. Additional STIR signal abnormality within the marrow posteriorly along the L4-5 disk is thought to be degenerative in etiology. No other osseous lesions are identified. The spinal cord displays normal signal and morphology and terminates at the L1-L2 level. The paravertebral soft tissues are unremarkable. T2 hyperintense cystic lesions are again visualized within the liver parenchyma and the bilateral adrenal glands appear thickened, grossly unchanged. Also seen are two lesions in the right nephrectomy bed. The more posterior lesion has fat signal intensity and measures 1.3 x 1.6 cm (series 6, image 6). More anteriorly what was described on the CT as a nodule previously also demonstrates some dropout of signal with minimal central enhancement and measures 9 x 9 mm (series 6, image 6). These lesions are grossly unchanged compared to the most recent abdomen and pelvis.Degenerative changes are seen in the cervical spine as described below:T12-L1: Trace disc bulge without significant compromise to spinal canal or neural foramina.L1-L2: Trace disc bulge and some ligamentum flavum thickening without significant compromise to spinal canal or neural foramina.L2-L3: Small disc bulge with mild left greater than right facet arthropathy and ligamentum flavum thickening which causes moderate left neural foraminal narrowing. There is mild to moderate spinal canal stenosis.L3-L4: Small to moderate disc bulge with facet arthropathy and ligamentum flavum thickening which causes mild right and moderate left neural foraminal narrowing as well as moderate spinal canal stenosis.L4-L5: Uncovering of the disc with a superimposed disc bulge. Moderate to severe facet arthropathy and ligamentum flavum thickening which contributes to moderate to severe spinal canal stenosis. There is associated redundancy and thickening of the cauda equina nerve roots. Moderate-severe right and mild-moderate left neuroforaminal narrowing. The exiting right L4 nerve root is slightly thickened which likely is related to inflammatory changes. Lobulated areas of increased T2 signal abnormality on the right at the L5 level dorsal to the thecal sac could be tiny synovial cysts arising from the medial aspect of the right facet joint.L5-S1: Uncovering of the disc as well as a superimposed disc bulge which causes moderate bilateral neural foraminal stenosis. No spinal canal stenosis.
1.The L3 vertebral body lesion is felt to represent progression of a degenerative Schmorl's node rather than a metastatic lesion. Follow up cross-sectional imaging is recommended in 6 months to ensure definite stability, although prior body CT suggests subtle abnormality in this area dating back to 2013. No other osseous lesions identified.2.Progression of the multilevel degenerative changes most severe at the L4-5 level where there is up to moderate to severe right neuroforaminal and spinal canal stenosis. Slight progression of grade 1 anterolisthesis at this level.3.The exiting right L4 nerve root is slightly thickened which likely is related to inflammatory changes from impingement.4.Grossly stable appearance to the right nephrectomy bed lesions which at least partially contain fat.