Seizure. Weakness. History of metastatic thyroid cancer with recent diagnosis of cord compression. This study is moderately limited by patient motion.BRAIN:Of note, susceptibility-weighted imaging was not performed. There is no acute infarct, mass-effect, midline shift or brain herniation. A few nonspecific T2-hyperintense lesions are present in the cerebral white-matter. The ventricles and the other CSF-containing spaces are normal in size. Following contrast infusion, there is no abnormal parenchymal or leptomeningeal contrast enhancement. There is no expansile, destructive skull lesion. There is moderate right ethmoid mucosal thickening. The orbits are grossly unremarkable.CERVICAL SPINE:There is fatty marrow signal in the cervical/upper thoracic spine, probably reflective of previous radiation treatment. There is a T1-hypointense, T2-hyperintense, contrast-enhancing lesion in the C7 vertebral body without osseous expansion, epidural extension or pathologic fracture. There is no suspicious cervical mass or lesion otherwise.Sagittal alignment is anatomic. The cervical spinal canal is developmentally narrowed. There is mild multilevel vertebral body height loss throughout the cervical spine, probably reflective of osteopenia and associated minimal compression. There is multilevel degenerative disease most pronounced at C3-C4 where disc-osteophyte complex and ligamenta flava thickening result in moderate-to-severe spinal canal stenosis associated with cord volume loss and mild, patchy increased T2 signal but no abnormal enhancement. A small bulge at C6-C7 causes mild spinal canal stenosis. Multilevel facet and uncovertebral arthropathy is associated with moderate left C3-C4 neural foraminal stenosis while C7-T1 ligamenta flava thickening results in no significant spinal canal stenosis. The left internal jugular vein is small in the left lower neck which might be developmental. Otherwise, the major neck vessels show preserved flow voids. A lobulated fatty density area with thick T1/T2-hypointense rim may reflect atypical lipoma associated with scarring.THORACIC SPINE:There is patchy T1-hypointense, STIR-hyperintense, contrast-enhancing signal abnormality in the left superior aspect of T6 vertebral body associated with mild height loss. This may represent a relatively recent compression fracture. Otherwise, the marrow is heterogeneous throughout the thoracic spine though without a discrete focal lesion. There are intravertebral herniations at T7-T8, T9-T10 and along the inferior endplate of T10. The spinal canal is notable for dorsolateral indentations by facet arthropathy and ligamenta flava thickening, most pronounced at T2-T3, where there is moderate spinal canal and mild neural foraminal stenosis, and to a lesser extent T6-T7, T7-T8, T10-T11 and T11-T12. There is suggestion of multiple pulmonary nodules but these are better assessed by CT scan of the chest, if clinically warranted.LUMBAR SPINE:Axial T1 and T2-weighted images were not obtained. Of note, there are 4 lumbar-type vertebrae and the last well-formed disc is between L4 and the sacralized L5. There has not been change since the recent examination of April 25, 2016. The heterogeneous lesion involving all the L4 and the lower part of L3 vertebral bodies is unchanged as well as its posterior extension and expansion along the left pedicle, articulating pillars and to a lesser extent lamina and right pedicle. The associated 25% posterior height loss at L4 vertebral body is also unchanged with mild posterior retropulsion narrowing the left subarticular recess. There is also abnormal contrast enhancement in soft tissues surrounding the left L3-L4 facet and the left L4 pedicle and lamina but no sizable epidural mass.The multilevel degenerative disease has not changed but results in no significant spinal canal stenosis. Neural foraminal stenoses are most pronounced in the lower lumbar spine; moderate-to-severe left and mild-to-moderate right L3-L4 as well as moderate bilateral L4-L5. Please refer to the report of the previous examination for more details.The tip of the conus medullaris lies at L1-L2 level. There is no abnormal contrast enhancement in the conus or the cauda equina roots.Noncontrast enhancing foci within the kidneys and the liver are incompletely assessed but may represent cysts.
1.Transitional spinal anatomy, as noted above. If surgery is to be contemplated, please correlate with imaging of the entire spine.2.BRAIN: There is no acute infarct or brain mass.3.CERVICAL SPINE: Multilevel degenerative cervical spondylosis is most pronounced at C3-C4 where there is moderate-to-severe spinal canal stenosis with minimally increased cord T2 signal and volume loss at the same level, probably compressive myelopathy. Contrast-enhancing lesion in C7 vertebral body is probably metastatic but is not associated with epidural extension/osseous expansion or pathologic fracture.4.THORACIC SPINE: Heterogeneous thoracic marrow signal but no discrete mass. Focal marrow signal abnormality in T6 vertebral body may represent a recent mild insufficiency compression fracture. Multilevel degenerative change is most pronounced at T2-T3, where facet arthropathy and ligamenta flava thickening result in moderate spinal canal stenosis. Suggestion of multiple pulmonary metastasis.5.LUMBAR SPINE: Stable metastatic lesions in the lumbar spine, without significant epidural disease. There is no compression of the conus or cauda equina.