Male, 30 years old, history of Ewing's sarcoma, status post cryoablation in January of 2014, with findings concerning for progressive disease on a scan from July 2014, status post second cryoablation in August 2014, assess for progression of disease, recent cryoablation resulted in paralysis. Again seen is the sequelae of prior ablation and cement placement within the T10 vertebral body. This includes bilateral transpedicular access tracts and low signal centrally within the vertebral body likely related to the presence of cement. There is abnormal STIR signal and enhancement involving this vertebral body extending into the pedicles not significantly changed since 11/19/2014.Again seen is thinning of the spinal cord at the T10 level. The cord seems to be retracted anteriorly towards the vertebral body as seen before. There is slight decrease in enhancement along the anterior aspect of the cord at this level. Abnormal T2 signal involves the central cord bilaterally as well as ventrally slightly more inferiorly at T10.Interval increase in size of T12 vertebral body lesion, previously 6x6 mm, now 20 x 15 in the AP and craniocaudal dimensions in the sagittal plane. There is also a 9x11 mm lesion measured similarly which is new since 11/19/2014 MRI. These lesions are hypermetabolic on PET from same day.Elsewhere, there signal characteristics are unremarkable. There is minimal loss of height at T10 involving the superior endplate which is stable to minimally worse than prior. Vertebral body heights are otherwise preserved. Spinal alignment is anatomic. The remainder of the spinal cord shows normal signal intensity and morphology. No evidence of spinal canal stenosis or neuroforaminal narrowing is detected.
1. Compared to MRI 11/19/2014, there is progression of osseous metastatic disease in the thoracic spine with enlarging T12 lesion and new T3 lesion. These lesions are hypermetabolic on PET from same day.2. Previously treated enhancing T10 vertebral lesion is not significantly changed. There is minimal depression of the superior endplate which is slightly worse than prior. Otherwise no compression fractures. No epidural tumor. 3. Sequela of prior cryoablation related injury to the thoracic cord with mild cord atrophy and ventral cord enhancement at T10; enhancement is slightly decreased in the interval consistent with evolution of injury.