Left lower extremity weakness, bowel and bladder incontinence. History of metastatic breast cancer. There is extensive T2 hyperintensity involving the thoracic cord extending from the C7 to the T4 levels with mild cord expansion. There is a T2 hypointense intramedullary lesion at the T1 level measuring approximately 5 mm, previously approximately 28 mm in the craniocaudal dimension.Degenerative changes are seen in the cervical spine with disc osteophyte complexes at the C4-C5, C5-C6, and C6-C7 levels. There is minimal retrolisthesis at C5 on C6. Mild cervical spinal canal narrowing related to degenerative disease. Vertebral body heights and alignment in the cervical spine are otherwise maintained.In the thoracic spine at the T6-T7 level there is disc extrusion which appears less prominent than before. There is mild degree of spinal canal stenosis at this level. Possible T2 signal abnormality at this level, sagittal STIR image 7 but appears less severe than before. Vertebral body heights and alignment in the thoracic spine are otherwise maintained.In the lumbar spine, again seen is mild loss of height at the L2 level compatible with a chronic compression fracture. Vertebral body heights and alignment in the lumbar spine are otherwise maintained. Mild degenerative changes throughout the lumbar spine are also seen without significant spinal canal stenosis. There is severe loss of disc height at the L5-S1 level on a degenerative basis. Mild to moderate L5-S1 neural foraminal stenosis.
1. Intramedullary lesion at the T1 level highly suspicious for cord metastasis is decreased in size, currently measuring 5 mm, previously 28 mm in the craniocaudal dimension on prior study from 12/8/2014. Surrounding edema is also decreased in the interval.2. Disc extrusion at the T6-T7 level appears less prominent than 12/8/2014. There is possible T2 signal abnormality in the cord at this level but not well evaluated without axial images. There was definite cord signal abnormality at this level previously, which was presumably related to the extensive edema from the T1 metastases. There is mild degree of spinal canal stenosis at this level. 3. Please note this is a limited exam per cord compression protocol. Consider dedicated total spine MRI with gadolinium to better assess the extent of metastatic disease.Dr. Ali discussed findings with Dr. Jacobs at 1130 hrs on 8/26/2015.