 There has been interval evolution of the disease burden involving the sacrum, with some areas that appear to be smaller with less enhancement , but some areas have enlarged with cystic and enhancing components, particularly within the left sacral ala and expanded spinal canal at S2, causing compression of the left S1 and S2 nerve roots and bilateral S3 nerve roots within the neural foramina. Otherwise, the previously demonstrated lesions in the lumbar vertebrae no longer enhance, suggestive of treatment response. The vertebral column alignment is within normal limits. The vertebral body heights are preserved. The spinal cord displays normal signal and morphology. There are hepatic cysts. There appears to be diffuse mural hyperenhancement of the bowel in the posterior pelvis.
1. Interval evolution of the disease burden involving the sacrum, with some areas that appear to be smaller with less enhancement in response to treatment, but some areas have enlarged with cystic and enhancing components, suggestive of tumor progression versus less likely superimposed infection, particularly within the left sacral ala and spinal canal, causing compression of the left S1 and S2 nerve roots and bilateral S3 nerve roots within the neural foramina. Otherwise, the previously demonstrated lesions in the lumbar vertebrae no longer enhance, suggestive of treatment response. 2. Diffuse mural hyperenhancement of the bowel in the posterior pelvis may represent inflammation.These findings were discussed with Dr. Kourosh Rezania at 4:40 PM on 7/28/2016.