Intermittent back pain. History of bone metastasis is from lung cancer. There is bone marrow edema surrounding the focal T1-hypointense, T2-hyperintense, contrast-enhancing lesions involving the anterior superior L2 vertebral body, left posterolateral L2 vertebral body, and left L5 vertebral body/pedicle junction. There is also a metastatic lesion involving the left L3 transverse process associated with abnormal signal and contrast enhancement in the ipsilateral vertebral body and pedicle marrow as well as the adjacent paraspinal soft tissues. Smaller osseous lesions are present in the spinous processes of T10, L3 and L4. There is no displaced pathologic fracture or osseous expansion. Similar metastatic involvement is present in the partially imaged right iliac bone and right sacral ala. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. There is mild disc bulges and desiccation at L4-L5 and L5-S1. The disc bulges, combined with facet arthropathy and ligamenta flava thickening, result in mild-to-moderate left and mild right L5-S1 and mild bilateral L4-L5 neural foraminal narrowings. There is no significant spinal canal stenosis. The caudal spinal cord displays normal signal and morphology. The tip of the conus medullaris lies at upper L2 level. There is a small lower sacral perineural cyst. There are multiple, poorly contrast-enhancing right renal masses, which are not completely imaged, compatible with metastasis. The left kidney is absent. There are small, nonspecific para-aortic lymph nodes.
1.Multiple spine and pelvic osseous metastasis, but no displaced, pathologic fracture, or osseous expansion. However, these metastatic osseous lesions are associated with surrounding marrow edema. The lesion in the left L3 transverse process is associated with abnormal signal in the adjacent soft tissues as well.2.Mild lower lumbar spondylosis worst at the left L5-S1 neural foramen causing mild-to-moderate stenosis. No significant spinal canal stenosis.3.Multiple right renal masses are not completely imaged, but compatible with metastasis. Please refer to the report of the abdomen/pelvis CT scan from May 25, 2016 for additional details. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.