 There is no evidence of acute compression of the thoracic cord or conus, or significant thoracic spinal canal stenosis. There is low T1 and high T2 signal abnormality within the T7 vertebral body extending to the left pedicle, right T8 pedicle and facet, left T10 inferior articulating facet and spinous process, as well as bilateral T11 pedicles facets and spinous process with involvement of the right T11 vertebral body as well. There is also signal abnormality in the bilateral T12 facets and spinous process. Evaluation is limited due to lack of IV contrast. However, these lesions correspond to hypermetabolism on the recent PET, and therefore consistent with metastases. There is expansion of the affected pedicles and facets with epidural tumor invasion causing severe stenoses of the right T7-8, T8-9, and T12-L1 neural foramina, as well as moderate stenoses of the left T7-8, and T9-10, and T10-11 neural foramina. There is severe bilateral stenoses of the T11-12 neural foramina. There is an incompletely imaged mass measuring up to 6.3 CC x 1.8 AP x 5.4 ML cm in the subcutaneous soft tissues superficial to the right paraspinous musculature with hypermetabolic activity on PET, consistent with subcutaneous metastasis. There is desiccation of the intravertebral discs from C6-7 through T10-11 with loss of disc height. There are mild left L2-3 and L3-4 neural foraminal stenoses from disc bulge, facet arthropathy and ligament flava thickening, incompletely imaged. The conus terminates at L1-2. The kidneys are markedly atrophic and contain numerous cysts bilaterally. There is a large cyst in the right posteromedial aspect of the liver without hypermetabolic activity on prior PET.
1.Numerous thoracic vertebral body and posterior element osseous metastases without evidence of acute fracture, compression of the thoracic cord or conus, or significant thoracic spinal canal stenosis.2.Tumoral expansion of the posterior elements at multiple levels with epidural tumor extension results in moderate to severe neural foraminal stenoses at multiple levels of the thoracic spine, as described in the findings section.3.A large, but incompletely characterized subcutaneous tissue mass in the lower back is consistent with a metastasisI personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.