 There is redemonstration of abnormal signal and enhancement involving the L1 vertebral body, with inferior endplate deformity and mild vertebral body height loss. There is continued ill-defined abnormal enhancement and signal within the anterior superior endplate of L2, although this is felt to relate to degenerative marrow changes and does not appear to represent a focal metastatic lesion, given previous lack of abnormality on bone scan at this level. There is also persistent metastatic disease within the visualized sacrum, with progression since the previous MRI. There are areas of extensive abnormal signal and enhancement involving the left hemisacrum, now involving S2 and more caudal levels, corresponding to large areas of lytic change on CT. There is also a persistent large left iliac metastasis appears increased in confluence since the previous MRI. Bilateral iliac involvement also extends to the acetabula, as previously noted, again progressed since previous bone scan.There is again diffuse enhancement and abnormal signal of the lower paraspinal musculature which may relate to denervation changes, with enhancement and abnormal signal within the subcutaneous fat which may represent dependent reactive changes.The lumbar spine is in stable alignment with trace grade 1 anterolisthesis of L5 on S1, with a normal lumbar lordosis. The vertebral body and disk heights are stable, with multilevel disc narrowing and desiccation. The distal spinal cord and conus are within normal limits with the conus terminating at the L1-L2 level.There is redemonstration of spondylotic changes at L1-L2 and L3-L4, with at most mild central spinal canal stenosis at L1-L2. There is redemonstration of a small enhancing T2 hypointense lesion along the cauda equina nerve roots centered at the L2-L3 level.
1. Stable appearance of osseous metastatic disease compared to more recent CT, with progression since prior MRI especially involving the left mid to lower sacrum without interval extension into sacral foramina. Stable L1 vertebral body metastatic lesion with mild compression deformity.2. Stable appearance of leptomeningeal nodule along the right cauda equina nerve roots at the L2-L3 level with minimal nodular enhancement.3. No significant interval progression of spondylotic changes.