Male, 66 years old, with metastatic head and neck cancer and increasing back pain. Cervical:Numerous areas of pathologic marrow replacement are demonstrated throughout the vertebral bodies and posterior elements of the cervical region. No significant compression deformities are suspected. No significant epidural disease extension is seen.Straightening of the cervical lordosis is evident. Spinal alignment is otherwise unremarkable. Vertebral body heights are preserved.Spinal cord signal intensity and morphology are unremarkable except as discussed below.C2-3: Left greater than right facet hypertrophy. Minimal posterior disk osteophyte formation. No significant spinal canal stenosis or neuroforaminal narrowing.C3-4: Left greater than right facet hypertrophy. Posterior disk osteophyte formation. Mild spinal canal narrowing with slight ventral cord flattening but no cord signal abnormality. Mild bilateral foraminal narrowing.C4-5: Mild right facet hypertrophy. Minimal posterior disk osteophyte formation. No significant spinal canal stenosis or neuroforaminal narrowing.C5-6: Marked bilateral facet hypertrophy. Posterior disk osteophyte formation. Moderate generalized spinal canal stenosis with mild mass effect on the cord. The cord tapers at this level and shows patchy bilateral T2 hyperintensity suggesting myelomalacia. Moderate to severe bilateral foraminal narrowing. C6-7: Facet hypertrophy. Mild posterior disk osteophyte formation. No significant spinal canal stenosis. Mild right foraminal narrowing. C7-T1: Facet hypertrophy. Posterior disk osteophyte formation asymmetric towards the right. Mild spinal canal narrowing with very slight ventral cord flattening but no cord signal abnormality. Mild to moderate right foraminal narrowing. Incidental note is made of asymmetry of the floor of mouth and right tongue base along with some supraglottic and mucosal thickening likely reflecting prior therapy.Thoracic:Since the prior examination, marked interval progression of patchy marrow replacement is seen. The vertebral bodies and posterior elements are affected at every visualized level with extensive involvement of the ribs as well.Epidural disease extension is suspected on the right at T6-7 with minimal encroachment upon the thecal sac but fairly significant infiltration of the right T6-7 neural foramen. Epidural disease extension is also suspected bilaterally at T7-8 with mild encroachment upon the thecal sac but infiltration of the neural foramina bilaterally. Infiltrating soft tissue is also evident between the T7 and T8 proximal ribs.The visualized spinal cord demonstrates normal signal intensity and morphology. No areas of significant spinal canal stenosis is seen. Except as discussed above, the neural foramina are unremarkable.Vertebral body heights are preserved. Spinal alignment is within normal limits.A mass is present at the left lung base along with a pleural effusion. Small nodules are also suspected within the visualized right lung.Lumbar:Areas of marrow replacement are seen at every lumbar vertebral level including the vertebral bodies and posterior elements. Scattered lesions are also evident the partially visualized sacrum and iliac bones.Vertebral body heights are grossly maintained and alignment is within acceptable limits.The visualized conus and cauda equina nerve roots are normal. No significant epidural disease extension is suspected.L1-2: Facet hypertrophy and ligamentum flavum thickening. Mild bulging disk. No significant generalized spinal canal stenosis. No significant neuroforaminal narrowing. L2-3: Facet hypertrophy and ligamentum flavum thickening. Mild bulging disk. No significant generalized spinal canal stenosis. Mild bilateral foraminal narrowing. L3-4: Facet hypertrophy and ligamentum flavum thickening. Bulging disk. Mild generalized spinal canal stenosis. Mild to moderate bilateral foraminal narrowing. L4-5: Facet hypertrophy and ligamentum flavum thickening. Bulging disk. No significant generalized spinal canal stenosis. Mild bilateral foraminal narrowing. L5-S1: Facet hypertrophy and ligamentum flavum thickening. Bulging disk with a small superimposed central protrusion. No significant generalized spinal canal stenosis. Mild left foraminal narrowing.
1.Widespread osseous metastatic disease, with evidence of progression at least when compared to a prior thoracic spine MRI, though more recent chest CTs show evidence of widespread metastatic disease as well.2.Mild epidural disease extension is evident at T6-7 and T7-8. This largely affects the neural foramina without significant compromise of the spinal canal.3.Mild/moderate generative disease is evident as above. There are findings suggestive of myelomalacia at C5-6 which may reflect chronic stenosis and cord impingement at this level.