 THORACIC SPINE: There is diffuse marrow heterogeneity of the thoracic spine with diffuse infiltration of the T1 through T4 vertebral bodies. Multiple scattered enhancing foci are noted throughout the thoracic vertebrae. There is involvement of the posterior elements at multiple levels, most prominent at the left greater than right T1-T2 level and right T5-T6 level. There is curvilinear enhancement of the epidural space at the ventral aspect of T1-T2 and T2-T3, ventral lateral and left posterior aspect of T3-T4, ventral and right lateral aspect of T4-T5, and right lateral aspect of T5-T6, representing epidural spread of tumor. The vertebral column alignment is within normal limits. The vertebral body heights are grossly maintained. There is no significant spinal canal stenosis. There is mild left T1-T2, left T2-T3 and right T5-T6 foraminal narrowing. There is minimal deformity of the posterior aspect of the thoracic cord at the level of T6-T7, which may be related to an arachnoid cyst. The spinal cord otherwise displays normal signal. Incidentally noted is a 14 mm adrenal nodule extending off the medial limb of the right adrenal gland. LUMBAR SPINE: The vertebral column alignment is within normal limits. There is diffuse marrow heterogeneity with multiple scattered foci of enhancement throughout the lumbar vertebrae, sacrum and iliac bones. There is diffuse marrow infiltration of the L1 and L3 vertebral bodies. There is minimal compression of the L1 and L3 vertebral bodies, suspected to be pathologic. There are Schmorl's nodes at the superior and inferior endplates of L3. There is mild left foraminal narrowing at L3-L4, related to small disc protrusion. There is advanced facet arthropathy of the lower lumbar spine. The distal spinal cord and conus are within normal limits with the conus terminating at the L2-L3 level. There is no abnormal leptomeningeal enhancement. Partially imaged is an enlarged uterus with presumed calcified leiomyomas as correlated with CT abdomen and pelvis of 1/27/2015.
1. Diffuse osseous metastases of the axial skeleton with epidural tumor involvement at upper to mid thoracic spine as described. No significant spinal canal stenosis or cord compression.2. Minimal pathologic compression deformities of the L1 and L3 vertebral bodies. No associated osseous retropulsion into the spinal canal.