 Compared to 7/23/2015, there is mild decrease in size of intradural enhancing mass at the L3 level. The mass previously measuring 14 x 19 x 30 mm now measures 14 x 18 x 25 mm in the AP, transverse, and craniocaudal dimensions. Mass is again noted to occupy the entire sac in the transverse plane. There is T1 shortening involving the marrow which may be related to radiation treatment. No suspicious osseous lesions in the lumbar spine are appreciated. No new intradural enhancing lesion.Again seen is a lesion involving the right sacrum with linear low T1 and T2 signal and surrounding enhancement. This finding is suboptimally visualized due to its location. Mixed lytic and sclerotic changes are seen on prior CT. Finding is most consistent with a healing fracture although an underlying osseous lesion is not entirely excluded. Vertebral body heights and alignment are maintained. Mild degenerative changes are seen as described below:T12/L1: UnremarkableL1/2: UnremarkableL2/3: Mild disc bulge without significant spinal canal or neural foraminal stenosisL3/4: Asymmetric bulge to the right, ligamentum flavum thickening, and mild bilateral facet hypertrophy. There is mild right neural foraminal stenosis as before. No significant spinal canal or left neural foraminal stenosis.L4/5: There is a small central disc protrusion with superimposed asymmetric bulge to the right. There is also ligamentum flavum thickening and mild bilateral facet hypertrophy. There is mild right neural foraminal stenosis. No significant spinal canal or left neural foraminal narrowing.L5/S1: Asymmetric bulge to the left causing mild left neural foraminal stenosis. No spinal canal or right neural foraminal narrowing.
1.Compared to 7/23/2015, there is decrease in size of intradural enhancing mass at the L3 level compatible with treatment response. No new lesions. 2.Partially visualized linear signal abnormality involving the right sacrum again seen which is favored to represent an insufficiency fracture. Underlying metastatic lesion seems less likely but not entirely excluded.