Metastatic prostate cancer, increased uptake at T12. Back pain. There is evidence of osseous metastatic disease with multiple lesions noted including the posterior aspect of the T8, T10, T11, and T12 vertebral bodies in the thoracic spine as well as L1, L2, and L3 in the lumbar spine. There is associated abnormal enhancement in most of these lesions. There is mild involvement of the posterior elements at T10 to L1. Vertebral body heights in the thoracic and lumbar spine are normal. Alignment is normal. No evidence of pathologic compression fractures. There is minimal enhancement dorsal to the T11 and T12 vertebral bodies which is favored to be reactive vascular enhancement rather than epidural tumor. No convincing evidence of epidural or leptomeningeal tumor. Postgadolinium images are slightly motion degraded.There is diffuse congenital narrowing of the thoracic and lumbar spine. There is prominence of the epidural fat which contributes to the stenosis. There are is moderate spinal canal stenosis at L3-L4 and L4-L5 related to disk bulge, facet arthropathy, and ligamentum flavum thickening. There is also moderate left and mild right L3-4 neural foramina stenosis. There is moderate left and mild right L4-L5 neural foramina stenosis. There is mild right L5-S1 neural foramina stenosis. There is facet arthropathy throughout the lumbar spine. Sclerotic lesion involving the left iliac wing is noted and was present on prior CT.
1. Osseous metastatic disease involving multiple levels in the thoracic and lumbar spine, as described above, with relative greatest involvement of the T11, T12, L1, and L3 vertebral bodies. No prior MRI is available for comparison, however, there is sclerosis at these levels dating back to at least CT from 6/6/2014.2. No pathologic compression fracture. There is minimal enhancement dorsal to the T11 and T12 vertebral bodies which is favored to be reactive vascular enhancement rather than epidural tumor. No convincing evidence of epidural or leptomeningeal tumor. 3. Congenital narrowing of the thoracic and lumbar spinal canal with superimposed degenerative changes. There is resulting moderate L3-4 and L4-5 spinal canal stenosis as well as neural foraminal narrowing as detailed above. 