71-year-old female with a history of metastatic breast cancer with extensive bony involvement, presenting with severe left shoulder and cervical spine pain. Please evaluate for disease and compression. Exam is limited given an incomplete exam and motion degradation. There is slight reversal of the upper cervical curvature centered at C4-5. There is diffusely abnormal bone marrow signal with relative sparing of the lower half of the C2 vertebral body as well as the C3 and C5 vertebral bodies. In comparison to the counting sequence on the previous thoracic spine MRI, the overall appearance of the cervical marrow appears grossly unchanged likely reflecting treated areas of metastatic disease. There is mild loss of vertebral body height involving the T3 vertebral body but which is unchanged compared to that seen on the T-Spine MRI from 7/6/2016.There is multilevel disc dessication and loss of disc height involving many of the discs, which most prominently involve the C4-5 and C6-7 levels. There are multi-level small disc osteophyte complexes but no high grade spinal canal stenosis. There are multiple areas of neuroforaminal narrowing, with up to bilateral left greater than right moderate to severe C4-5 neural foraminal narrowing and bilateral moderate to severe C6-7 neural foraminal narrowing. There is facet and uncovertebral hypertrophy at multiple levels in the cervical spine, for instance involving the left C4-5 level. Within the limitations of motion degradation, the cervical spinal cord has normal signal characteristics and overall morphology. The vertebral artery flow voids appear to be intact. Again seen is a large lobulated T2 hyperintense cystic structure in the posterior nasopharynx compatible with a mucous retention cyst, which is better seen on the prior head CT. The paraspinous soft tissue structures appear within normal limits.
1.Full evaluation is complicated by an incomplete exam and motion degradation. Within these limitations, there is a combination of treated metastatic disease in the cervical spine which appears grossly similar to the counting sequence on the prior thoracic MRI. 2.No change in the mild chronic compression fracture involving the T3 vertebral body compared to the recent prior MRI of the thoracic spine from 7/6/2016.3.Multilevel spondylotic changes of the cervical spine without high grade spinal canal stenosis and up to moderate to severe neuroforaminal narrowing involving C4-5 and C6-7 levels as described above.