 For the purposes of numbering, the most inferior well-defined disc space is labeled L5-S1. There are postsurgical changes of corpectomy at T12 with placement of strut graft at this level. Partial corpectomy involving the posterior aspect of the L1 vertebral body is also noted. Left lateral fusion hardware is seen from T11 to L1 with screws and rods. Posterior fusion hardware extends from the T9 to the L3 levels with bilateral pedicle screws and interconnecting paraspinous rods. Hardware is better assessed on same-day CT.No cord signal abnormality is appreciated although evaluation is limited for signal abnormality at the level of the hardware.Bony lesion involving the right lateral aspect of the vertebral body at L1 on same-day CT is obscured on MRI due to susceptibility artifact. There is a fluid collection with peripheral enhancement extending from the upper T12 to the L1-L2 level involving the right lateral epidural and paraspinous soft tissues. No significant mass effect on the thecal sac or evidence of compression of the conus or cauda equina nerve roots at these levels. The fluid collection measures up to 6 cm in the craniocaudal dimension and approximately 18 mm in width. On the left, there is soft tissue filling the left T11-T12 and T12-L1 neural foramen with mild enhancement. Note additional post gadolinium images were obtained without fat saturation to reduce artifact approximately 3 hours later.There are developmental anomalies involving the upper thoracic spine as seen on CT. Counting from superiorly with the first thoracic ribs associated with the T1 vertebral body, there appears to be a right T2 hemivertebra which is fused with the T3 level. The disc space immediately inferior is diminutive developmentally. Note however the numbering of the hardware above is from the inferior L5-S1 level.There is dextrocurvature of the upper thoracic spine, levocurvature of the midthoracic spine, as well as dextrocurvature of the lower thoracic spine. Vertebral body heights and alignment in the lumbar spine are maintained. No significant disc disease, spinal canal or neural foraminal stenosis in the lumbar spine.Approximately 1 cm T2 hyperintense lesion seen in the right inferior hepatic lobe which is not well assessed and if clinically indicated ultrasound may be considered.
1. Although there is susceptibility artifact from hardware, there is no evidence of significant spinal canal stenosis in the thoracic spine or lumbar spine. No evidence of cord compression. No appreciable cord signal abnormality, although assessment of cord signal abnormality at the level of the hardware is limited.2. Bony lesion which may represent residual or recurrent tumor involving the right aspect of the L1 vertebral body is better seen on CT and obscured on MRI due to artifact. Enhancing soft tissue fills the left T11-T12 and T12-L1 neural foramina and may represent scar tissue versus tumor. Would suggest obtaining prior imaging and preoperative extent of tumor to help differentiate. 3. Postoperative changes of tumor resection including T12 corpectomy as well as partial posterior L1 corpectomy with fusion hardware extending from T9 to L3 as detailed above. Hardware is better assessed on same-day CT. 4. Peripherally enhancing fluid collection measuring up to 6 cm in the craniocaudal dimension extending from the upper T12 to the L1-L2 level and involving the right lateral epidural and paraspinous soft tissues. No significant mass effect on the thecal sac. This collection is favored to represent a pseudomeningocele; superimposed infection can be considered in the appropriate clinical setting. 