Clinical question: 60-year-old female with metastatic cancer with known metastases to T12-L5, left pelvis, evaluate for any nerve. Signs and symptoms: As above. Pre and post enhanced thoracolumbar MRI:Examination demonstrates metastatic lesion extensively involving vertebral body of T2, left pedicle and left superior articulating facet with enhancement. There is ventral epidural extraosseous spread of tumor and with partial extension into the left neural foramen at this level. No evidence of fracture, spinal stenosis and no detectable cord signal abnormality.There is a small focus of metastatic disease involving the superior aspect of body of T11 with enhancement without fracture or extraosseous spread of tumor.Large osseous metastatic lesion involves the vertebral body of T12 without evidence of extension into the pedicles or the posterior elements and without detectable fracture or extraosseous spread of tumor.There is an enhancing metastatic lesion involving nearly entire L1 vertebral body with approximately 50% compression deformity of the vertebrae. There is extension of tumor into the right pedicle. There is no evidence of a spinal stenosis or neural foraminal compromise at this level.Large enhancing metastatic lesion involving the vertebral body of L4 without fracture or malalignment and without spinal canal or neural foraminal compromise.Large enhancing metastatic lesion involves the vertebral body of L5 and without fracture or malalignment and no evidence of epidural spread of tumor.The signal intensity and caliber of thoracic cord, conus and cauda equina is within normal and without evidence of leptomeningeal enhancement.Shallow ventral disc protrusion with enhancement at C5-T6 and T7-T8 levels are noted and best appreciated on sagittal post enhanced series.A large right thoracic mass abuts the spine however without convincing evidence of extension into the neural foraminal or the spinal canal at any level.
1.Multiple enhancing osseous metastatic lesions involving vertebral bodies of thoracic and lumbar spine.2.There is approximately 50% compression deformity of metastatic L1 vertebral body as detailed.3.There is mild ventral epidural and left neural foraminal extension of tumor from metastatic disease at T2 level as detailed.4.No convincing evidence of intracanalicular or neural foraminal spread of tumor at any other level.5.Normal signal intensity and caliber of the cord and without detectable cord or left meningeal enhancement.6.Very large right thoracic mass abuts the thoracic spine at multiple levels however without detectable spread of tumor into the neural foramina or spinal canal.