Female, 63 years old, with metastatic lung cancer presenting with dysarthria, gait instability, headache and nausea. New brain metastases on MRI. Cervical:A thin layer of enhancement along the brainstem and within the cerebellar fissures is partially visualized compatible with leptomeningeal metastatic disease. In the cervical region, there is also some evidence of subtle enhancement along the cord surface and some of the intrathecal nerve roots compatible with leptomeningeal metastatic disease.No definite evidence of osseous metastatic disease is seen in the cervical region. Spondylotic disease is better assessed on the prior precontrast C-spine exam.Thoracic:Subtle thin enhancement along the surface of the thoracic cord is seen on some slices compatible with leptomeningeal metastatic spread.Areas of pathologic enhancement are seen within the posterior superior aspect of the T3, T4 and T8 at vertebral bodies concerning for bony metastatic disease.A right-sided pleural fluid collection is partially visualized with a drainage catheter in place.Lumbar:Image quality is degraded by motion artifact, particularly on the postcontrast sequences. Within this limitation, the following observations are made.Diffuse enhancement of the nerve roots of the cauda equina is seen compatible with leptomeningeal metastatic spread.Bone marrow signal characteristics are generally heterogeneous. Superimposed upon this is an area of T1 hypointensity, T2 hyperintensity and mild enhancement involving the posterior inferior aspect of the L1 vertebral body.Spinal alignment is anatomic. Vertebral body height is preserved. Signal intensity of the sacrum and iliac bones is also heterogeneous with superimposed more localized lesions, at least one of which in the right iliac bone seems to enhance partially.T12-L1: Small right paracentral/foraminal protrusion. Mild generalized spinal canal stenosis. No significant neuroforaminal narrowing.L1-2: Bulging disk with superimposed central/left paracentral protrusion. Effacement of the left ventral thecal sac. No significant generalized canal stenosis. No significant foraminal narrowing. L2-3: Mild facet hypertrophy and ligamentum flavum thickening. No significant spinal canal stenosis. L3-4: Mild facet hypertrophy and ligamentum flavum thickening. Mild bulging disk. Mild generalized spinal canal stenosis. Mild bilateral foraminal narrowing. L4-5: Mild facet hypertrophy and ligamentum flavum thickening. No significant spinal canal or neuroforaminal stenosis. L5-S1: Mild facet hypertrophy and ligamentum flavum thickening. No significant spinal canal or neuroforaminal stenosis. A perineural root sleeve cyst is evident along the right S2 nerve root.
1. Evidence of leptomeningeal metastatic disease involving the entire spinal cord and cauda equina.2. Localized enhancing lesions in the T3, T4 and T8 vertebral bodies are concerning for osseous metastases.3. A lesion along the inferior aspect of the L1 vertebral body is indeterminate and could reflect degenerative disease or a metastatic lesion.4. Osseous metastatic disease is also suspected in the sacrum and iliac bones.