 Compared to MRI from 6/16/2015 there has been worsening of the diffusely heterogeneous bone marrow signal abnormality. There are new discrete lesions involving the upper aspect of the T1 vertebral body, right T7 transverse process, right lamina and spinous process of T9, left lamina and spinous process of T11, and bilateral lamina and spinous process of T12. There are also lesions involving the T12 and L1 vertebral bodies. Additional small lesions are seen such as the right transverse process at T2 and multiple bilateral ribs which are suboptimally imaged due to motion degradation on the axial sequences of the upper thoracic spine. There is tumor involving the dorsal epidural space at the T12-L1 level with mild narrowing of the spinal canal at this level. There is also minimal dorsal epidural tumor related to the T9 lesion without spinal canal stenosis. There is also minimal right anterior epidural tumor associated with the L1 lesion. There is suggestion of minimal epidural tumor at the ventral T4 level, with motion degraded axial images limiting precise evaluation.There is diffuse low T1 and low T2 signal involving the T4 vertebral body indicative of sclerosis with approximately 60% loss of height, new since prior. No associated osseous retropulsion or spinal canal stenosis. Aside from the T4 level, vertebral body heights in the thoracic spine are maintained. Alignment is maintained. Neural foramina in the thoracic spine are preserved. Aside from the mild stenosis at the T12-L1 level, spinal canal in the thoracic spine is also preserved. No cord signal abnormality.
1. Evidence of interval development of osseous metastatic disease throughout thoracic spine and partially imaged chest wall as detailed above. 2. There is dorsal epidural tumor at the T9 and T12-L1 levels as well as anterolateral epidural tumor at the L1 level. There may be minimal epidural tumor at the T4 level which is not well assessed. There is mild associated narrowing of the spinal canal at the T12-L1 level.3. There is a sclerotic appearing lesion involving the T4 vertebral body with moderate compression fracture. No associated osseous retropulsion or spinal canal stenosis.