80-year-old male with lower extremity weakness that began 2 days ago and the sudden onset. Evaluate for cord compression. MRI Cord compression protocol:Severely motion limited exam with high suspicion of cord compression spanning from the T5 vertebral level through approximately T7. Therefore, additional sequences were obtained in the axial plane in attempt to better visualized the thoracic spine as described below. Elsewhere outside the thoracic spine, there is evidence of diffuse osseous metastatic disease which is progressed compared to the prior MRI exam from 11/18/2011. There are degenerative changes involving the cervical spine, upper thoracic spine and lumbar spine with scoliosis but without evidence of cord compression or high grade stenosis in these regions. MRI thoracic spine:Again seen is diffuse metastatic disease involving the vertebral bodies of the thoracic spine, progressed compared to the previous MRI exam. Motion degradation artifact limits full evaluation. Within these limitations, there is suspected severe spinal canal stenosis secondary to circumferential tumor encasing the spinal cord and spanning from the T5-6 to T6-7 vertebral body levels. There is questionable cord signal abnormality at this level not well assessed. There is also evidence of tumor within the the spinal canal to a somewhat lesser degree spanning from the T7 level to the T10 level. There is prominent dextroscoliosis of the thoracolumbar spine which has progressed compared to the prior MRI.MRI lumbar spine:There is diffuse osseous metastatic disease involving the visualized lumbar spine and pelvis which has progressed compared to the MRI from 11/18/2011 but unchanged compared to the CT abdomen and pelvis from 2/1/2016. With an unchanged mild compression fracture involving the L1 vertebral body anteroinferiorly, which along with severe disc loss, causes a mild focal kyphosis at this level. There is also mild rightward lateral translation of L2 on L3 and severe loss of disc height at this level. There are areas of minimal to mild vertebral body height loss at multiple levels relatively more prominent at T10.There are multilevel degenerative changes throughout the lumbar spine with disc bulges, facet arthropathy, and ligamentum flavum thickening. There is no significant central spinal canal stenosis at any level in the lumbar spine. There is multilevel neural foraminal stenosis, relatively worst at the right L5-S1 level.
1.Motion degradation artifact limits full evaluation. Within these limitations, there is suspected severe spinal canal stenosis secondary to circumferential epidural tumor spanning from the T5-T6 to T6-T7 vertebral body levels. There is questionable cord signal abnormality at this level but poorly assessed. Contrast enhanced imaging is recommended for further evaluation. Consider anesthesia assistance given the extensive motion.2.There is also tumor involvement of the spinal canal to a somewhat lesser degree spanning from the T7 level to the T10 level.3.Multilevel degenerative changes are visualized as described above but there is no evidence of high-grade spinal canal stenosis or cord compression in the remainder of the cervical, upper thoracic or lumbar spine.4.Findings were discussed with Dr. Choi of the Heme-Onc service at the time of the preliminary entry for the patient at 08:16 pm on 8/27/2016 by Dr. Veronesi, Neuroradiology Fellow.