76-year-old female with right lower extremity weakness and history of renal cell carcinoma metastases to the spine. There is abnormal bone marrow signal in the S1 and S2 segments of the sacrum, which corresponds to an ill-defined sclerotic and lytic lesion in the prior CT. There is an additional area of abnormal signal within the right posterior superior L5 vertebral body and right pedicle. Mild loss of vertebral height is noted at the S1 segment. The vertebral bodies are otherwise appropriate in the overall alignment and height. There is also abnormal signal in the L5-S1 intervertebral disc. The spinal cord has normal signal characteristics and overall morphology. There is no compromise of the spinal cord. Small posterior disc osteophyte complexes are present in the cervical spine, most conspicuous at C3-C4. Combined with mild ligamentum flavum hypertrophy/facet arthropathy, this results in mild spinal canal stenosis. There is no area of high-grade spinal canal stenosis in the spine. Moderate degenerative changes are noted in the lower lumbar spine with associated moderate to severe narrowing of the right L5-S1 neural foramen. No additional areas of high-grade neural foraminal stenosis are identified throughout the spine. Within the presacral region, there is increased STIR signal and low T1 signal, which is slightly heterogeneous and perhaps related to fluid, versus less likely mass given the relatively normal appearance of the presacral area on recent CT. Moderate bilateral pleural effusions are noted. There is a subcentimeter round focus of hyperintensity in the inferior pole of the left kidney.
1. Findings suggestive of metastatic lesions L5, S1, and S2. Loss of height at S1 suggestive of pathologic compression fracture.2. No spinal cord compression is identified. This is a limited exam specific for the exclusion of cord compression only and does not exclude more subtle lesions such as intrinsic cord abnormalities.3. Degenerative changes in the lower lumbar spine with associated moderate to severe narrowing of the right L5-S1 neural foramen. Correlation with patient symptoms is suggested.4. Bilateral pleural effusions are incidentally noted, new since prior CT.5. Abnormal signal in the presacral region may represent fluid. New presacral mass is felt to be less likely given the short time course since prior CT and presacral space appeared relatively normal. 