Clinical question: 21-year-old male with metastatic testicular tumor, evaluate spine for metastases versus leptomeningeal enhancement. Signs and symptoms: N/V, metastatic disease, rule out leptomeningeal disease. Pre and postcontrast enhanced total spine MRI:Cervical spine demonstrate normal signal intensity and alignment of vertebral column. Normal signal intensity and caliber of the cervical cord.No evidence of enhancing metastatic lesion of the vertebral column, cord or the meninges.No appreciable degenerative disease, no central spinal stenosis or neural foraminal compromise.Thoracic spine MRI demonstrate normal anatomical morphology, signal intensity and alignment of vertebral column without detectable metastatic lesions.Normal signal intensity, caliber and morphology of thoracic cord without detectable abnormal enhancement of the cord or the leptomeninges to suggest metastatic disease.Incidental note is made of partially visualized pulmonary nodules/masses as well as reported on prior chest x-ray.Lumbosacral spine MRI demonstrate a single focus of T1 hypointense, T2/T2 STIR hyperintense and enhancing lesion in the vertebral body of L4 measuring at 6 x 8.5 mm on sagittal post enhanced fat-sat series 3201 image 11. The lesion is most demarcated and demonstrate no surrounding marrow edema and is a nonspecific finding. However considering history of testicular cancer possibility of a single osseous metastatic lesion cannot be entirely excluded. The signal intensity of the vertebral column is otherwise within normal on all MRI sequences and without detectable abnormal enhancement. The signal intensity and morphology of the conus and the cauda equina is within normal and without detectable abnormal enhancement.No appreciable degenerative disease of the lumbosacral spine and no detectable neural foraminal or spinal compromise/stenosis.
1.Examination demonstrate a single 6 x 8.5 mm focus of marrow signal change with enhancement in the vertebral body of L4. The finding is nonspecific but likely a benign lesion, however considering patient's history of metastatic testicular cancer less likely possibility of a single osseous metastatic lesion cannot be entirely ruled out.2.Unremarkable pre and enhancement total spine MRI otherwise.3.No appreciable degenerative disease, no spinal stenosis or neural foraminal compromise at any level.4.Incidental note is made of partially visualized pulmonary nodules/masses as was reported on prior chest x-ray.