Clinical question: Metastatic breast cancer. Signs and symptoms: Worsening pain. Nonenhanced Lumbar MRI:Examination demonstrates less than 50% compression fracture of the superior endplate of T12 with resultant mild kyphotic deformity. There is T2 STIR hyperintensity and T1 hypointensity of the T12 marrow space suggestive of edema. Finding is concerning for a metastatic lesion. The finding has remained stable since prior CT of abdomen from 4-13-15. There is mild ventral bulge of the superior aspect of T12 vertebra into the spinal canal resulting in subtle mass effect and posterior displacement of the cord however without spinal stenosis or neural foraminal compromise and no detectable signal abnormality of the cord.Large focus of marrow signal replacement within the vertebral body of L1, tiny focus in the body of L2, diffusely in of vertebral bodies of L3 and L4 as well as small focus in the inferior S2 vertebral body also suspected of osseous metastatic lesions. There is no detectable extraosseous spread of tumor and no evidence of spinal canal compromise or stenosis. No evidence of neural foraminal compromise at any level.Nonenhanced thoracic MRI:Examination demonstrates diffuse patchy foci of marrow signal replacement involving both the vertebral bodies, pedicles and the articulating facets at multiple levels and consistent with diffuse metastatic lesions. There is normal signal intensity and caliber of the thoracic cord.There is no convincing evidence of extraosseous spread of tumor into the spinal canal or perispinal soft tissues on this nonenhanced exam areaNo evidence of spinal stenosis or neural foraminal compromise at any level. Mild degenerative disease is however noted.
1.Nonenhanced MRI of lumbar spine demonstrate diffuse metastatic lesions of the lumbosacral spine as detailed. Stable less than 50% compression fracture of T12 with a slight kyphotic angulation compared to prior exams. No spinal stenosis or neural foraminal compromise at any level. Normal signal intensity and caliber of the lower most visualized thoracic cord, conus and cauda equina. No detectable extraosseous spread of tumor on this nonenhanced exam.2.Nonenhanced thoracic MRI demonstrate diffuse patchy foci of marrow signal changes consistent with metastatic disease however without fracture or malalignment and no detectable extraosseous spread of tumor. No spinal stenosis or neural foraminal compromise at any level. Normal signal intensity and caliber of thoracic cord.