 As seen on CT from earlier the same date, there are diffuse osseous metastatic lesions throughout the spine with signal abnormalities most consistent with a sclerotic foci identified previously. In the cervical spine, there are multiple posterior disc osteophyte complexes and scattered metastatic lesions, which partially efface the spinal canal, but do not cause direct mass effect on the cord and there is no signal abnormality in the cervical spine. In the thoracic spine there are multilevel metastatic lesions, most notably at T3 and T8 where there is significant marrow infiltration and cortical expansion. There is collapse of the T3 vertebral body with extrusion of the T2-3 disc as well as cortical retropulsion, causing mass effect on the ventral cord and cord T2 hyperintensity at this level. There is involvement of the posterior elements at T3. CSF is effaced at this level resulting in central stenosis, however sagittal STIR technique demonstrates a tiny amount of residual CSF posteriorly.There is also direct extension of metastatic disease via cortical expansion into the posterior elements at the T8 level with direct extradural metastatic invasion into the ventral spinal canal resulting in mass effect on the cord and resultant cord T2 hyperintensity. Overall the cord is displaced posteriorly by this mass effect and is compressed against the posterior epidural fat, which is maintained, without compression against osseous elements. Additional metastatic lesions and resultant canal narrowing are also seen at L1-2 L3-4 and L4-5. Multiple renal cysts are better evaluated on same-day CT.
1.Multilevel osseous metastatic disease.2.There is collapse of the T3 vertebral body with extrusion of the T2-3 disc as well as cortical retropulsion, causing mass effect on the ventral cord and cord T2 hyperintensity at this level. CSF is effaced at this level resulting in central stenosis, however sagittal STIR technique demonstrates a tiny amount of residual CSF posteriorly.3.There is direct extension of metastatic disease via cortical expansion into the posterior elements at the T8 level with direct extradural metastatic invasion into the ventral spinal canal resulting in mass effect on the cord and resultant cord T2 hyperintensity. Overall the cord is displaced posteriorly by this mass effect and is compressed against the posterior epidural fat, which is maintained, without compression against osseous elements. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.