Stage IV melanoma. Worsening lower back pain. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. The conus medullaris is normal in position. There is diffuse heterogeneity of the bone marrow with multiple osseous lesions throughout the lumbar spine consistent with known metastatic disease. Several of these lesions demonstrate minimal enhancement and no significant edema, which may represent treated lesions. The largest enhancing lesions are seen involving the L4 and S1 vertebral bodies and are also associated with STIR hyperintensity/edema. There is no evidence of pathologic compression fracture. No evidence of epidural tumor. The right sacral lesion abuts the right S1 nerve root in the neural foramen, without significant foraminal stenosis.Multilevel degenerative changes are seen with mild disc desiccation throughout the lumbar spine, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: There is a disc bulge with a central protrusion component and annular fissure. There is fairly mild spinal canal narrowing. There is also minimal narrowing of the bilateral neural foramina. L4-L5: There is a disc bulge, moderate bilateral facet arthropathy, and ligamentum flavum thickening which contribute to moderate spinal canal stenosis. There is mild to moderate bilateral neural foraminal stenosis.L5-S1: Disc bulge and bilateral facet arthropathy. No significant spinal canal or neural foraminal stenosis. Partially imaged pelvis demonstrates multiple lesions involving the sacrum and bilateral iliac bones. Please refer to separate for findings in the pelvis.
1. Multiple osseous lesions in the lumbosacral spine consistent with known metastatic disease. Relatively larger enhancing lesions are evident at the L4 and right S1 levels. No evidence of pathologic compression fractures or epidural tumor. 2. There is moderate spinal canal stenosis at the L4-L5 level which is on a degenerative basis.3. Please refer to separate for findings in the pelvis.