Weakness and paresthesia, new diagnosis neuroendocrine small cell lung cancer with metastasis. Rule out cord compression. Again seen is patchy marrow replacement involving many of the vertebral bodies of the spine concerning for diffuse metastatic disease. However, there is no significant loss of vertebral body height. At the C5-6 and C6-7 level there is substantial T2 hypointensity within the ventral epidural space which causes displacement and compression of the spinal cord. There is evidence of a small amount of cord signal abnormality at the C7 level which is confirmed on the recent previous outside hospital MRI exam of the spine. The signal characteristics involving the ventral epidural space at the C5-6 and C6-7 level suggests disc extrusion although the adjacent vertebral bodies are infiltrated by metastatic disease and therefore the possibility of disc mixed with tumor can be considered. Dedicated contrast enhanced exam of the cervical spine may provide additional information on this.Prominent disc herniation at the L5-S1 level with degenerative endplate changes causes moderate spinal canal stenosis at that level. There is no other significant spinal canal stenosis elsewhere in the cervical, thoracic or lumbar spine. Incidental note is made of thyroid gland enlargement and a left thyroid nodule.
1.This is a limited exam specific for the exclusion of cord compression only and does not exclude more subtle lesions such as intrinsic cord abnormalities. Due to the screening nature of this protocol details are not as evident on imaging as dedicated protocols of the spine.2.Extensive patchy marrow replacement involving the majority of the spine consistent with extensive osseous metastatic disease.3.Low T2 intensity material in the anterior epidural space at the C5-6 and C6-7 level causing cord compression and possibly cord edema. The signal characteristics suggest disc extrusion although the adjacent vertebral bodies are infiltrated by metastatic disease and this could possibly be due to disc mixed with tumor. Dedicated contrast enhanced cervical spine imaging is pending which may provide additional information.4.Prominent disc herniation at the L5-S1 level with endplate degeneration causes moderate spinal canal stenosis at that level. 