 Counting of the thoracolumbar spine utilized both the current lumbar spine MRI acquisition as well as the sagittal reconstruction from the previous chest/abdomen/pelvis CT demonstrating that there are 12 ribs, with 4 lumbar-type vertebral bodies and transitional anatomy which includes sacralization of L5.The previously described lesion within the L5 vertebral body, using the counting nomenclature described above, lies within the L4 vertebral body and demonstrates edema with STIR imaging as well as enhancement. This extends to involve not only the anterior elements but also the posterior element elements, notably on the left. This is associated with approximately 25% collapse of the posterior vertebral body. Enhancement also extends to involve the left facet as well as the left paraspinal soft tissues.Edema with enhancement is also noted involving the inferior L3 vertebral body, more prominent on the right, with a small amount of right adjacent soft tissue enhancement.Although a small amount of T2 signal is present within the intervening L3/4 disc, there is no associated enhancement.Marrow throughout the remaining osseous elements demonstrates heterogeneity, without discrete STIR signal abnormality or enhancement.The conus is normal in signal and morphology and terminates at an appropriate level. Please see dictation for CT chest/abdomen/pelvis performed yesterday for full description of abnormal abdominal findings.T12/L1: Asymmetric bulge to the left and bilateral facet hypertrophy. There are no significant stenoses.L1/2: Asymmetric bulge to the right, ligamentum flavum thickening, and facet hypertrophy. There is mild right lateral recess, mild left neural foraminal, and moderate right neural foraminal stenosis.L2/3: Asymmetric bulge to the left and facet hypertrophy. There is mild left neural foraminal stenosis.L3/4: Asymmetric bulge to the left and facet hypertrophy. There is mild left lateral recess, moderate to severe left neural foraminal, and mild to moderate right neural foraminal stenosis.L4/5: Diffuse annular disc bulge and bilateral facet hypertrophy. There is moderate bilateral neural foraminal stenosis.L5/S1: Unremarkable
1.The previously described lesion within the L5 vertebral body, using the counting nomenclature described in the findings section above, lies within the L4 vertebral body and demonstrates edema with STIR imaging as well as enhancement. This extends to involve not only the anterior elements but also the posterior element elements, notably on the left. This is associated with approximately 25% collapse of the posterior vertebral body. Enhancement also extends to involve the left facet as well as the left paraspinal soft tissues.2.Edema with enhancement is also noted involving the inferior L3 vertebral body, more prominent on the right, with a small amount of right adjacent soft tissue enhancement.3.Although a small amount of T2 signal is present within the intervening L3/4 disc, there is no associated enhancement of the disc.4.The constellation of these features is most consistent with metastatic disease.5.Marrow throughout the remaining osseous elements demonstrates heterogeneity, without discrete STIR signal abnormality or enhancement, which may reflect early osseous involvement from metastases.