Further assessment of a T11 lytic lesion with possible extension into the spinal canal. Cervical spine: There is reversal of the normal lordosis. The vertebral body height is relatively preserved accounting for the due to spondylosis. The vertebral bone marrow signal is diffusely heterogeneous with loss of the normal fatty signal, but there is no osseous expansion. There is a similar appearance of the clivus and sphenoid body. There is no significant spinal canal stenosis. The spinal cord shows normal signal and morphology.Thoracic spine: The vertebral column alignment is within normal limits. There is mild loss of T2 signal and height at the T4-T5 disc. Otherwise, the disc space heights are preserved. The marrow is heterogeneous with loss of the normal fatty signal. Similar involvement is present in the included ribs. There is a more intensely T1-hypointense, T2 hyperintense abnormality replacing the T11 vertebral body/pedicle marrow with mild, predominantly left sided posterior expansion/retropulsion but no significant spinal canal narrowing. This is also associated with central compression/intravertebral disc herniations along the superior and inferior endplates indicating bone softening but without overall vertebral body height loss. The appearance is unchanged since the CT scan. The other vertebral body heights are preserved. A T1 and T2 hyperintense lesion in T9 vertebral body is probably a hemangioma. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.Lumbar spine: There is minimal anterior subluxation of L4 relative to L5 which is degenerative, without spondylolysis. The alignment is otherwise anatomic. The vertebral body heights are preserved. The marrow is heterogeneous with loss of the normal fatty signal. Similar involvement is present in the included pelvic bones. There is nonspecific mild T1-hypointense, T2 hyperintense signal just posterior to the lumbar vertebral bodies, displacing the epidural fat posteriorly. There is degenerative stenosis of the spinal canal, which is severe at L4-L5 and moderate at L5-S1, superimposed on congenitally narrow spinal canal. The conus medullaris has normal morphology and signal. The tip of the conus medullaris is at mid L1 level. The paravertebral soft tissues are unremarkable.LEVEL-BY-LEVEL
1.Diffuse marrow infiltrating process with more focal, destructive involvement of the T11 vertebral body and pedicles associated with mild retropulsion, but no spinal cord compression or significant canal narrowing. The appearance is more suggestive of multiple myeloma rather than prostate cancer metastasis, although the assessment is somewhat limited by the lack of intravenous contrast.2.Multilevel cervical and lumbar degenerative spondylosis, including severe spinal canal narrowing at L4-L5.