Clinical question: Neurology request to evaluate for cord compression; known sacral lytic lesion. 66-year-old male with metastatic prostate cancer. Signs and symptoms: Numbness lower extremities up to the rectum and penis; back pain. Pre-and post-enhanced lumbar MRI:Examination demonstrate extensive marrow signal changes of vertebral bodies and the posterior elements of the lumbar spine and visualized sacrum and iliac wings consistent with extensive osseous metastatic lesions from patient's known prostate cancer. There is no meniscal fracture or malalignment of vertebral column. Enhancing metastatic lesions at S2 and S3 demonstrate significant expansion into the ventral epidural space and with resultant complete obliteration of the subarachnoid space. Very minimal presacral expansion of tumor is noted. There is no evidence of spinal stenosis secondary to number at any other levels. There is no meniscal fracture of vertebral column.Pre-and post-enhanced thoracic MRI:Examination demonstrate marrow signal replacement and enhancement consistent with metastatic disease involving the entire osseous structures of thoracic spine. There is normal anatomical alignment the vertebral column however with mild exaggeration of thoracic kyphosis. There is no significant epidural spread of tumor into the spinal canal at any level. There is mild central spinal stenosis in the upper thoracic spine which is believed to be secondary to degenerative changes however possibility of overlapping thin epidural spread of tumor cannot be entirely excluded. This mild spinal stenosis extends from approximately T2 to T6 level. The signal intensity and caliber of thoracic cord remains within normal and without or abnormal enhancement.
1.Pre-and post-enhanced MRI of lumbar spine demonstrate extensive osseous metastatic lesions involving the entire visualized lumbosacral spine and lower most visualized thoracic spine. There is no fracture or malalignment. There is significant intracanicular spread of tumor from S2 and to a lesser degree S3 metastatic lesions with resultant significant central spinal stenosis. No spinal stenosis at any other level.2.Pre-and post-enhanced MRI of thoracic spine demonstrate osseous metastatic disease involving the entire osseous structures of thoracic spine. There is mild central spinal stenosis extending from T2 through T6 which is primarily due to degenerative changes however minimal epidural spread of tumor as a contributing factor cannot be excluded. There is normal signal intensity and caliber of thoracic cord without abnormal enhancement.