 There is stable 5-6-mm grade 1 anterolisthesis of L3 on L4, retrolisthesis of L4 on L5 as well as minimal grade 1 retrolisthesis of L5 on S1. The spine is otherwise in normal alignment. There is diffusely abnormal marrow signal, with numerous areas of abnormal T1 hypointensity and STIR hyperintensity consistent with known osseous metastatic disease. Since the prior MRI, there has been interval mild-moderate compression deformity of the T2 vertebral body along the superior endplate as well as mild compression deformity of T7. Better delineated on the prior CT, there is diffuse osseous metastatic disease at L4 with a pathologic fracture along its inferior endplate resulting in mild compression deformity and dorsal convexity of the posterior vertebral body margin. This in combination with prominence of dorsal epidural fat results in likely moderate-severe if not severe central spinal canal stenosis. There is also mild to moderate right and severe left foraminal narrowing at L4-L5 along with moderate right foraminal narrowing L5-S1.The vertebral body heights are otherwise well-maintained, with multilevel disk narrowing scattered throughout the spine, most severe at L4-L5. The distal spinal cord and conus are grossly within normal limits with the conus terminating at the approximate L1-L2 level. There is developmental narrowing of the lumbar central spinal canal due to short pedicles and proliferation of epidural fat.There are multilevel cervical spondylotic changes, most conspicuous from C4-C5 to C6-C7 where there is likely moderate central spinal stenosis. These appear grossly similar to the prior outside images.Incidental note is made of slight crowding at the level the foramen magnum, with the cerebellar tonsils extending approximately 5 mm below the level of the foramen magnum, although retaining a rounded morphology. There is a partially visualized right sided pleural effusion. A few T2 hyperintense lesions are suggested within the right cerebellum which are nonspecific.
1. Diffuse osseous metastatic disease with redemonstration of pathologic inferior endplate fracture of L4 with dorsally convex posterior vertebral body margin secondary to tumor/retropulsion, resulting in moderate-severe if not severe central spinal canal stenosis as well as severe left foraminal narrowing at L4-L5, especially when superimposed upon spondylotic changes and prominence of dorsal epidural fat. Stable grade 1 retrolisthesis of L4 on L5.2. Since prior outside MRI, mild-moderate compression deformity of T2 and mild compression deformity of T7.3. Partially visualized T2 hyperintense lesions within the right cerebellum. These are nonspecific although concerning for metastatic disease, and MRI of the brain with and without contrast is recommended for further evaluation.4. Partially visualized right sided pleural effusion.