Female, 38 years old, with metastatic breast cancer now presenting with left groin numbness and subtle left lower extremity weakness. With the exception of T11, all of the visualized vertebral bodies, as well as the sacrum and iliac wings, demonstrate heterogeneous hypointense T1 and T2 signal compatible with sclerotic metastases.Vertebral body height and morphology are otherwise within normal limits. Spinal alignment is anatomic. No evidence of any enhancing paraspinal or epidural soft tissue disease is seen.A 3 mm enhancing nodule is evident within the left aspect of the thecal sac at the L4-5 level, apparently in association with the left S1 or S2 nerve roots (see image 14 series 11). The nerve roots of cauda equina are otherwise unremarkable. No other pathologic intrathecal enhancement is seen.At L5-S1, there is significant loss of disc height and mild disc bulging with osteophytic spurring. No significant spinal canal stenosis is seen. Mild encroachment upon the left neural foramen is noted. No significant disc bulge or disc herniation is seen at the remaining lumbar levels. No other areas of spinal canal or foraminal stenosis are detected. Mild facet arthropathy is seen at lower lumbar levels.
1.Diffuse sclerotic osseous metastases are seen without evidence of any pathologic epidural or paraspinal soft tissue tumor encroachment.2.A nodule of enhancement is seen within the left aspect of the thecal sac at the L4-5 level, probably in association with either the left S1 or S2 nerve roots. This could represent an incidental nerve sheath tumor. Given the history, however, the possibility of intrathecal tumor spread would need to be considered as well.3.Significant disc degeneration at L5-S1 one which does result in some encroachment on the left neural foramen.