Reason: evaluate for malignancy. Patient with known primary maligancy, leg weakness and radiculopathy. Punctate nodules of enhancement are present along the correlate quinine at that L3-4, L4-5 and L5-S1 levels.Small foci of low signal are reidentified at the L3 and L4 which do not enhance following gadolinium administration.Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is a moderate to marked degree bilateral facet hypertrophy present at this level. There is a ringlike enhancing adjacent to the right facet joint which has high signal centrally and low signal peripherally on T2 imaging and is hypointense centrally on T1 imaging comparedAt L4-5 there is bilateral facet hypertrophy right more than left with associated hypertrophy of the right-sided ligamentum flavum more than left. There is additional disk bulge present at this level and effacement of the fat of the right lateral recess resulting in encroachment of the nerve roots of the right lateral recess. There some mild encroachment of the exiting nerve root within the right neural foramen at this level. It overall there is a mild degree of spinal stenosis at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is diffuse disk bulge and mild to moderate facet and ligamentum flavum hypertrophyAt L2-3 there is effacement of spinal fluid surrounding the cauda equina associated with diffuse disk bulge and mild ligamentum flavum hypertrophy. Overall there is mild/moderate spinal stenosis at this level.At L1-2 there is effacement of spinal fluid surrounding the cauda equina associated with diffuse disk bulge and mild ligamentum flavum hypertrophy. Overall there is mild spinal stenosis at this level.There is a large right-sided cystic lesion at the inferior pole of the right kidney which is not entirely included on this exam and appears to measure about 8 cm in size.
1.Several punctate lesions in the lower cauda equina are present. Differential considerations include leptomeningeal metastases, drop metastases and nerve sheath tumors.2.There are degenerative changes present in the lumbar spine with encroachment of the nerve roots of the right lateral recess at L4-5 related to disk disease and facet disease.3.There are degenerative changes present in the lumbar spine with the mild to moderate spinal stenosis at L2-3. There is mild spinal stenosis at L1-2.4.There appears be a synovial cyst associated with the right L5-S1 facet joint.5.Lesions present at L3 and L4 are suspected to represent sclerotic foci. Lack of contrast enhancement would tend to suggest that these are benign. In patients with prostate cancer. Nuclear medicine exam is more sensitive in detecting spinal metastases.6.There is an 8 cm cystic lesion present along the right kidney. It is not adequately evaluated on this lumbar spine MRI exam.