Metastatic thyroid cancer. Low back pain with right-sided radiculopathy Five lumbar type vertebral bodies are present. Multiple enhancing lesions are seen throughout the lumbar spine as well as the visualized T11 and T12 vertebral bodies, sacrum, and iliac bones. Relatively largest of the lumbar lesions seen at the L3 level measuring 2.0 x 1.7 x 2.1 cm. There is a larger right sacral lesion at S1 and S2 measuring 3.1 x 3.8 x 3.8 cm in the AP, transverse, and craniocaudal dimensions. There is some neural foramina narrowing with possible impingement of the exiting right S1 nerve root. There is S2 lesion measuring 2.7 x 4.0 x 3.9 cm. There is mild epidural tumor extent greater on the left than the right.Schmorl's node is present involving the superior endplate of T12 with minimal loss of anterior vertebral body height. Otherwise no compression fractures are seen. The conus medullaris is normal in position. No evidence of epidural tumor in the lumbar spine or leptomeningeal disease.Mild multilevel degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: No significant disc disease. No spinal canal or neural foraminal stenosis.L4-L5: Mild disk bulge, ligamentum flavum thickening, and facet arthropathy result in mild spinal canal narrowing. Mild to moderate bilateral neural foramina stenosis.L5-S1: Mild disk bulge and facet arthropathy without significant spinal canal stenosis. There is mild right neural foramina stenosis. No significant left neural foramina narrowing.Right adrenal lesion also noted compatible with metastasis and seen previously.
1. Diffuse metastatic disease in the lumbar spine as well as visualized lower thoracic spine and pelvis, as seen on prior PET.2. Mild loss of height involving the T12 vertebral body with underlying metastatic lesion and Schmorl's node. Otherwise no other pathologic fractures. No osseous retropulsion or significant spinal canal stenosis. 3. Large sacral lesion demonstrates mild epidural extension at the S2 level without high grade spinal canal stenosis. No epidural tumor in the lumbar spine. 4. Degenerative changes including mild disk bulges in the lower lumbar spine and facet arthropathy which may also be contributing to low back pain. Mild right sided neural foramina narrowing at L4-L5 and L5-S1 related to degenerative disease as well as narrowing of the right S1-S2 neural foramen related to tumor, which may be impinging on the exiting right S1 nerve root. There may also be impingement of the left S2 nerve root related to S2 metastatic lesion.