Metastatic urothelial cancer. Lumbar metastatic disease. Evaluate for disease in cervical spine. Prior study from 7/7/2015 was severely motion degraded. Cervical spine: Examination of the cervical spine is mildly motion degraded. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. There is straightening of the cervical spine, alignment is otherwise maintained. The cervical spinal cord has normal signal characteristics and overall morphology. Bone marrow signal appears within normal limits. No suspicious lesions to suggest metastatic disease are appreciated.Cervical spinal canal appears congenitally narrow with superimposed mild degenerative changes including mild disc bulges at C3-C4, C5-C6, and C6-C7. Individual levels as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: Mild spinal canal narrowing with effacement of the ventral and dorsal thecal sac. No significant neural foraminal stenosis.C4-5: Mild spinal canal narrowing with effacement of the ventral and dorsal thecal sac. No significant neural foraminal stenosis.C5-6: Mild spinal canal narrowing with effacement of the ventral and dorsal thecal sac. No significant neural foraminal stenosis.C6-7: No significant compromise to the spinal canal or left neural foramina. Mild right-sided neural foraminal narrowing related to eccentric disc bulge.C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.Thoracic spine:There is heterogeneous bone marrow signal abnormality involving the T12 vertebral body likely representing metastatic disease. Motion degradation limits evaluation for small lesions; within this limitation, no additional osseous within the remainder of the thoracic spine are appreciated.There is enhancing epidural tumor extending superiorly from the upper T11 level and extending inferiorly into the upper lumbar spine. Epidural tumor predominantly involve the right lateral aspect of the spinal canal with significant mass effect on the thoracic cord at the T11 and T12 levels. Examination is suboptimal for evaluation of cord signal however no definite cord signal abnormality is appreciated. There is severe narrowing with tumor filling the right T11-T12 and T12-L1 neural foramina due to tumor.Vertebral body heights and alignment are maintained. No significant spinal canal narrowing in the remainder of the thoracic spine is appreciated.Please refer to recent CT for findings of extensive metastatic disease in the chest and abdomen.
1. Please note motion degradation limits evaluation for small lesions. Metastatic osseous lesion involving the T12 vertebral body is again seen. No suspicious lesions within the cervical spine or the remainder of the thoracic spine are appreciated. No pathologic fractures.2. Epidural tumor involving the right lateral aspect of the spinal canal with severe spinal canal stenosis and mass effect on the cord at the T11 and T12 levels. Tumor is also noted to fill the right T11-T12 and T12-L1 neural foramina.3. Mild degenerative changes in the cervical spine with mild spinal canal stenosis, as detailed above.4. Please refer to separate CT report for findings of extensive metastatic disease in the chest, abdomen, and pelvis.