Male, 45 years old, with metastatic renal cell carcinoma and increasing neck pain. Known thoracic spine metastases. Bone scan with questionable focus in the right cervical spine. The right lateral mass of C1 is infiltrated and expanded by pathologic enhancing soft tissue. This process extends to involve the adjacent paraspinal soft tissues such that the right longus coli muscle is displaced anteriorly. There may be minimal epidural extension of this process as it infiltrates around the dens, but no significant mass effect is exerted upon the thecal sac. No definite pathologic intradural enhancement is observed.C2 is not definitely involved by the above-mentioned process, nor is the occipital condyle. Likewise no definite additional disease is seen in the cervical spine. Pathologic marrow signal and enhancement is visualized at the T4 level.Spinal alignment is anatomic. Vertebral body heights are preserved. Except as above, marrow signal characteristics are unconcerning. Mildly elevated T1 and T2 signal within the C4 vertebral body may represent a benign hemangioma or focal fat.The visualized spinal cord shows normal signal intensity and morphology throughout. No pathologic cord or leptomeningeal enhancement is observed.The intervertebral disc spaces are preserved. No significant disc herniations or osteophytic spurring are seen. No significant spinal canal or foraminal stenosis is suspected though there may be mild scattered foraminal narrowing secondary to facet hypertrophy.Multiple small nodules are evident in the lung apices.
Metastatic involvement of the right lateral mass of C1 is seen on this examination. The lesion is expansile and extends into the adjacent paraspinal soft tissues. There may be some mild epidural disease extension, but no significant mass effect is exerted upon the thecal sac or the spinal cord.No definite additional metastatic disease is seen in the cervical spine. Thoracic spine metastatic disease is partially visualized on this examination.No evidence of significant spinal canal or neuroforaminal stenosis is observed.