Clinical question: Rule out cord compression/cauda equina. Signs and symptoms: Bowel incontinence and metastatic breast cancer. Nonenhanced complete spine MRI:Examination demonstrate diffuse patchy foci of marrow signal changes consistent with previously known diffuse osseous metastases disease.There is also evidence of mild compression deformity of T6, T7, T8, T11 and L1 vertebral bodies. There is mild expansion of compressed vertebrae at the one into the spinal canal with resultant complete effacement of the subarachnoid space and flattening and posterior displacement of the cord and central spinal stenosis. There is no evidence of cord signal abnormality.Compared to prior CT examination from February 3rd of 2015 there is no convincing evidence of internal progression of this finding. Very minimal bulge of compressed T6 vertebrae into the spinal canal with mild compromise of the spinal canal is also present. There is also a shallow ventral epidural soft tissue density at the level of compressed T8 vertebrae which is suggestive of small epidural spread of tumor. There is no evidence of any significant spinal canal compromise at these levels. The signal intensity of the cord also remains normal.There is significant exaggeration of thoracic kyphosis secondary to multilevel compression deformity without change since prior chest CT.There is evidence of bilateral pleural effusion which are only partially visualized and measure maximum of 16 mm in thickness on the right.MRI of thoracic spine:Axial T2 weighted images of thoracic and spine were also acquired which demonstrate the small focus of epidural spread of tumor on the left at T5 level without spinal stenosis and shallow ventral epidural spread of tumor at T8 as detailed above.MRI of lumbar spine:Additional axial T2-weighted images of the lumbar spine were also acquired for her assessment of one compression fracture. These images confirm mass effect on the cord and complete effacement of subarachnoid space and spinal stenosis. Compromise of bilateral neural foramina at this level is also detected.
1.Examination demonstrate diffuse osseous metastatic lesions involving the entire visualized lower cervical, thoracic and lumbosacral spine as detailed.2.Significant compression fracture of L1 with extension into the spinal canal results in mass-effect and posterior displacement of the cord and central spinal stenosis as detailed. The fracture demonstrates no significant change since prior studies.3.There is no detectable signal abnormality of the cord or the conus. 4.Multi-additional levels of mild compression fractures of the thoracic spine without significant compromise of canal or mass effect on the cord. There is however result in significant kyphotic deformity of the thoracic spine.5.Bilateral pleural effusions are detected.