49-year-old woman with history of metastatic breast cancer, now with lower back pain radiating down the legs bilaterally. There is a nodular enhancing mass involving the conus medullaris and cauda equina roots. The largest of these lesions appears intramedullary and measures 10 x 9 mm in axial dimension and 22 mm in craniocaudal dimension centered at the T12 level. There appears to be associated intraparenchymal invasion, with surrounding edema. Additionally, there are nodular enhancing lesions along the dural surface of the cauda slightly superiorly at the T11/T12 level and involving the left L4 cauda equina roots. In addition, there is amorphous enhancing tumor in the sacral spinal canal, with extension into the right S1/S2 neural foramen. The conus medullaris is situated at L1/L2 level. The vertebral body and intervertebral disc heights are within normal limits. The lumbar spinal alignment is within normal limits. The bone marrow signal is unremarkable. There are slight disc bulges at L3/L4, L4/L5, and L5/S1, but no significant spinal canal or neural foraminal narrowing. The paraspinous soft tissues are within normal limits.
Multiple tumors involving the conus medullaris, cauda equina, and sacral spinal canal are compatible with metastatic disease.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.