Male, 59 years old, with history of lung cancer with rib and spine pain. Assess for the presence of a neoplastic process. Cervical:A trace degenerative retrolisthesis of C3 relative to C4 is demonstrated. Spinal alignment is otherwise unremarkable. No areas of worrisome marrow replacement or marrow edema are seen.No definite cord signal abnormality is seen. Questionable ill defined increased signal in the mid cervical cord, seen on the sagittal STIR and axial T2 sequences, but not the sagittal T2 sequence, may be artifactual and/or related to motion artifact.On post constrast images, no pathologic marrow space, epidural, or intradural enhancement is seen.C2-3: Right facet hypertrophy. No significant spinal canal or foraminal stenosis.C3-4: Facet hypertrophy. Disk osteophyte formation. Mild generalized spinal canal stenosis. Mild to moderate left foraminal stenosis.C4-5: Facet hypertrophy. Disk osteophyte formation. No significant spinal canal stenosis. Moderate left and mild right foraminal narrowing. C5-6: Left facet hypertrophy. Disk osteophyte formation with a focal component at the right subarticular/foraminal zone. No significant generalized parenchymal canal stenosis, but the right lateral thecal sac is effaced. Mild right foraminal narrowing. C6-7: Disk osteophyte formation, particularly along the left uncovertebral joint. No significant spinal canal stenosis. Mild left neuroforaminal narrowing.C7-T1: Facet hypertrophy. Otherwise, unremarkable.Thoracic:There is a slight curvature in the coronal plane, but alignment is otherwise unremarkable.A mild alteration of the marrow signal intensity in the upper and mid thoracic region may reflect radiation related change. Some of the upper thoracic vertebral bodies demonstrate a very subtle non uniform pattern of enhancement which is also favored to be treatment related. There is no definite evidence of any marrow space metastatic disease.The spinal cord demonstrates normal signal intensity and morphology. On postcontrast images, no concerning epidural or intradural enhancement is seen.Mild disk bulging is seen at T11-12 without significant spinal canal stenosis. A small left paracentral disk protrusion is present at T12-L1, again without significant stenosis.Elsewhere, the intervertebral disks are preserved with no compromise of the spinal canal or neural foramina.Partially visualized are numerous pulmonary nodules, some of which may be larger than on the prior exam. Volume loss and scarring is demonstrated in the right upper lung.Lumbar:The lumbar lordosis is straightened and there is a mild degenerative retrolisthesis of L5 relative to S1. A nonspecific, low signal, presumably sclerotic lesion is seen within the right iliac bone. No concerning marrow replacement or pathologic marrow enhancement is seen.The visualized spinal cord, conus and cauda equina are unremarkable. No pathologic epidural or intradural enhancement is seen.L1-2: Mild facet hypertrophy and ligamentum flavum thickening. Loss of disk height and bulging disk with a small left paracentral disk protrusion. No significant spinal canal stenosis. No significant foraminal narrowing. L2-3: Mild facet hypertrophy and ligamentum flavum thickening. No significant spinal canal or neuroforaminal stenosis. L3-4: Moderate facet hypertrophy and ligamentum flavum thickening. Mild laterally bulging disk. No significant spinal canal or neuroforaminal stenosis. L4-5: Mild facet hypertrophy and ligamentum flavum thickening. Mild bulging disk, particularly in the foraminal zones. Mild generalized spinal canal stenosis. Mild bilateral foraminal narrowing. L5-S1: Moderate facet hypertrophy. Loss of disk height with mild bulging and perhaps a very small central protrusion. No significant spinal canal stenosis. Mild bilateral foraminal narrowing.
1.No definite evidence of metastatic disease in the spine.2.Mildly altered signal intensity and pattern of enhancement within the mid to upper thoracic vertebral bodies is favored to represent a radiation related change.3.Questionable ill defined T2 signal abnormality is noted within the cervical spinal cord. This could be artifactual, as it is not confirmed on every sequence, and as there is some motion degradation on this exam. Follow-up imaging can be considered if clinical symptoms persist.4.Mild to moderate degenerative findings as discussed by level above.5.Numerous pulmonary nodules are partially visualized. Please consider dedicated chest imaging to assess for the possibility of interval growth.