Metastatic thyroid cancer. Fecal incontinence, back pain radiating to knee Thoracic:Again seen is evidence of metastatic disease at multiple levels in the thoracic spine. Relatively largest of the lesions are at the T7, T11, and T12 vertebral levels. No prior thoracic spine MRI is available for comparison, but the larger of the osseous lesions appear unchanged since 11/19/2014 CT chest study. There is no associated epidural tumor. No cord compression or signal abnormality. There is minimal loss of height involving the T7, T11, and T12 vertebral bodies similar to CT chest dating back to 11/19/2014.Right adrenal nodule again seen.Lumbar:Five lumbar type vertebral bodies are present. Multiple enhancing lesions are again seen throughout the lumbar spine as well as the visualized T11 and T12 vertebral bodies, sacrum, and iliac bones. Relatively largest of the lumbar lesions seen at the L3 level measuring 2.0 x 1.7 x 2.1 cm and unchanged. There is a larger right sacral lesion at S1 and S2 measuring 3.1 x 3.8 x 3.8 cm in the AP, transverse, and craniocaudal dimensions and also unchanged. There is some neural foramina narrowing with possible impingement of the exiting right S1 nerve root but unchanged. There is S2 lesion measuring 2.7 x 4.0 x 3.9 cm. There is mild epidural tumor extent greater on the left than the right.No lumbar compression fractures are seen. The conus medullaris is normal in position. No evidence of epidural tumor in the lumbar spine or leptomeningeal disease.Mild multilevel degenerative changes are seen, 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: No significant disc disease. No spinal canal or neural foraminal stenosis.L4-L5: Mild disk bulge, ligamentum flavum thickening, and facet arthropathy result in mild spinal canal narrowing. Mild to moderate bilateral neural foramina stenosis.L5-S1: Mild disk bulge and facet arthropathy without significant spinal canal stenosis. There is mild right neural foramina stenosis. No significant left neural foramina narrowing.
1. Diffuse metastatic disease in the thoracic and lumbar spine which is not significantly changed since MRI of the lumbar spine from 1/7/2015 and CT of the chest from 11/19/2014.2. Mild pathologic compression fractures in the thoracic spine remain unchanged.3. No evidence of epidural tumor or cord compression in the thoracic or lumbar spine. 4. Again seen is a large sacral lesion with epidural tumor extension at the S2 level without high grade spinal canal stenosis and unchanged. There is narrowing of the right S1-S2 neural foramen related to tumor, which may be impinging on the exiting right S1 nerve root. There may also be impingement of the left S2 nerve root related to S2 metastatic lesion. These findings appear not significantly changed since 1/7/2015.5. Unchanged degenerative changes including mild disk bulges in the lower lumbar spine and facet arthropathy. Mild right sided neural foraminal narrowing at L4-L5 and L5-S1 related to degenerative disease.  