 Cervical spine: Compared to 1/24/2015, there is evidence of progression of osseous metastatic disease with multiple new new lesions involving all levels in the cervical spine. Relatively largest lesion measures 1 cm involving the C3 vertebral body and not present previously. Vertebral body heights are maintained. Unchanged exaggerated cervical lordosis and minimal anterolisthesis of C4 on C5, C5 on C6 and minimal retrolisthesis of C6 on C7. Mild degenerative changes are also again seen in the cervical spine including multilevel facet arthropathy and small disc osteophyte complexes at the C5-C6 and C6-C7 levels as well as ligamentum flavum thickening. There is no significant spinal canal or neural foraminal stenosis in the cervical spine. There is no evidence of pathologic compression fractures. No evidence of epidural tumor.Thoracic spine: Sagittal post gadolinium images were not obtained and there is motion degradation on several sequences. Interval progression of osseous metastatic disease is seen with multiple new thoracic vertebral bodies demonstrating more diffuse infiltrative low T1 signal such as T3, T5, T7, T8 with intervening vertebral bodies at T4 and T6 again demonstrating abnormal marrow signal. Evidence of extension into the posterior elements again noted. No new pathologic compression fractures with maintained vertebral body heights. No thoracic cord signal abnormality or evidence of mass effect on the on the thoracic cord. There is slightly exaggerated thoracic kyphotic curvature as seen before.Lumbar spine: There is motion degradation on several sequences limiting evaluation for subtle abnormalities. Interval progression of osseous metastatic disease is seen with multiple new lumbar vertebral bodies demonstrating infiltrative low T1 marrow signal such as L2, L4, L5, S1, and S3. Alignment is maintained. No pathologic compression fractures. There is epidural tumor extending from T12 to L2 which has progressed in the interval. There is near circumferential epidural tumor at the L1 level measuring approximately 6 mm in thickness ventrally with mild spinal canal stenosis at this level. Conus tip is at the lower L1 level. Tumor infiltration and expansile appearance of the pedicle also results in moderate right-sided neural foraminal stenosis at the right L1-L2 level. Mild progression of paraspinous soft tissue tumor extension also noted at the right L1 level. No significant spinal canal stenosis more inferiorly. There are mild multilevel degenerative changes without high-grade spinal canal or neural foraminal stenosis at any level. Multiple new metastatic lesions throughout the visualized pelvis also noted.
1. Compared to 1/24/2015, there is evidence of progression of diffuse osseous metastatic disease with multiple new lesions involving the cervical, thoracic, and lumbar spine and visualized pelvis. 2. No evidence of pathologic compression fractures. No evidence of cord or cauda equina compression. There is interval increase in epidural tumor from the T12-L2 levels with now mild spinal canal stenosis (at the level of the conus) related to near circumferential epidural tumor at the L1 level. L1-L2 neural foraminal narrowing related to epidural tumor also appears slightly worse.3. Please note sagittal post gadolinium images of the thoracic spine were not obtained which may detect small epidural tumor in the thoracic spine. Patient may return for this sequence at no charge if clinically indicated. This would however be likely not associated with high grade spinal canal stenosis in the thoracic spine based on the other available thoracic sequences. 