Female, 53 years old, with back pain. The T12 vertebral body demonstrates diffuse marrow replacement and pathologic enhancement along with a compression deformity resulting in approximately 50% loss of vertebral body height. Retropulsion of disc material and nearly circumferential epidural soft tissue extension results in effacement of the thecal sac, a moderate generalized spinal canal stenosis, and slight deformation of the adjacent conus without convincing cord signal abnormality. The T12-L1 left neural foramen also seems to be mildly narrowed. These findings have progressed from the recent prior body CT.Additional smaller foci of marrow replacement and abnormal enhancement are detected within the T11, L1 and L3 vertebral bodies, and the right sacrum. There is no evidence of vertebral body compression or epidural soft tissue extension at these levels.Spinal alignment is anatomic apart from a mild kyphotic angulation centered at T12. The intervertebral discs are largely preserved with only mild loss of disc height and disc bulging seen at L5-S1. No significant spinal canal stenosis or neuroforaminal narrowing is detected except as discussed above. Large Tarlov cysts are evident within the sacral foramina.Partially imaged is a large left renal mass.
1.Multiple sites of abnormal marrow replacement and pathologic enhancement are demonstrated within the lower thoracic and lumbar vertebral bodies and sacrum concerning for metastatic disease.2.The most severely affected level is T12 where disease results in a compression deformity with 50% loss of vertebral body height, as well as retropulsion and nearly circumferential epidural disease extension resulting in a moderate generalized spinal canal stenosis and slight deformation of the adjacent conus.