Clinical question: Rule out cord compression. Signs and symptoms: Urinary/bowel incontinence. Nonenhanced lumbar MRI:Examination demonstrates a large destructive enhancing mass involving vertebral bodies of S1-S3 and their posterior elements. There is extraosseous spread of tumor into the spinal canal at these levels which is completely occupied by the mass. There is significant extension of mass into bilateral neural foraminal There is significant extraosseous spread of mass into the left pelvis and left presacral space, extensive extension into the sacral canal which is nearly completely occupied by tumor as well as bilateral neural foraminal of the sacral region.Additionally exam demonstrates fairly extensive lymphadenopathy on the left anterior to the spine.The left presacral mass measures at least at 52 x 55 mm in transaxial dimensions. The largest transaxial dimensions of partially visualized nodes measures at 50 x 36 mm in transaxial dimensions. This cluster of nodes measures approximately at 140 mm in cranial cephalad access and extending from T12-L1 inferiorly to the pelvis.There is significant expansion of the bladder.Nonenhanced total spine MRI:Examination is performed utilizing cord compression protocol without axial series.Examination demonstrates extensive tiny foci of marrow signal replacement with hypointense T1 and hyperintense T2 and T2 STIR signal pattern highly suspicious for metastatic disease. The findings are present throughout the cervical and thoracolumbar spine. On sagittal post enhanced images of the dedicated lumbar MRI the lesions demonstrate enhancement and all highly suspected of diffuse metastatic lesions.
1.Nonenhanced total spine (cord compression protocol) MRI exam demonstrate numerous tiny foci of marrow signal replacement involving extensively the vertebral column highly suggestive of metastatic lesions.2.Dedicated pre and postcontrast enhanced lumbar MRI demonstrate a large destructive enhancing mass involving S1, S2 and S3 vertebral bodies, extensively occupying the sacral canal at these levels, large extraosseous component in the left pelvis and extensively of the sacral neural foraminal as detailed. There is extensive loculated lymph nodes within the abdomen on the left paraspinal tissues extending from T12-L1 to the pelvis as detailed/measured above.3.Significant expansion of the bladder. 