Female, 55 years old, with history of metastatic breast cancer presenting with back pain and bowel incontinence. Assess for leptomeningeal tumor spread. Marrow replacement has progressed at T12 now involving nearly the entire vertebral body. Focal marrow space lesions within the L1-L3 vertebral bodies have also increased in size since the prior examination. Ill-defined marrow replacement involving the right aspect of L5, a small lesion in S1, and marrow replacement in the right iliac wing also appear larger. At no level is there any significant paraspinal or epidural disease extension. No pathologic spinal cord or leptomeningeal enhancement is seen.Vertebral body heights are preserved. Fatty replacement of the spine from L1 down is compatible with prior radiotherapy. A mild scoliotic curvature of the lumbar spine is seen but sagittal alignment is anatomic. Generalized edema is seen within the posterior paraspinal musculature. A metastatic deposit in the posterior soft tissues at T11 has increased in size.Multiple intra-abdominal findings including liver nodularity, a left adrenal region mass and ascites, are better assessed on dedicated abdominal imaging.At L1-2 through L3-4, there is no significant spinal canal or foraminal stenosis.At L4-5, there is mild facet hypertrophy and mild disc bulging but no significant spinal canal or foraminal stenosis.At L5-S1, there is moderate facet hypertrophy and mild disc bulging, no significant spinal canal stenosis, but mild right foraminal narrowing.
Progressive osseous metastatic disease in the lumbar spine, but without evidence of epidural extension, spinal canal or foraminal compromise, or leptomeningeal spread.