Clinical question: 45 year-old with metastatic lung cancer. Assess for acuity of compression fracture of L2. Has prior L4 vertebroplasty. Signs and symptoms: Low back pain. Pre and post enhanced Thoracic MRI:Examination demonstrates a fairly extensive osseous metastatic lesions involving vertebral bodies and the posterior elements of the thoracic spine. There is no evidence of fracture or malalignment. There is however progression of disease since prior MRI study from January of 2015. There is mild expansion of tumor into the ventral epidural space at T11 and T12 levels with resultant mild central spinal stenosis. Epidural spread of tumor at T12 also extends laterally to the left and partially into the left T11 -- T12 neural foramina. There is also mild epidural spread of tumor at T6, T7 and T9 levels and posteriorly at T3 level. There is however no appreciable compromise of the spinal canal secondary to this finding.The signal intensity and caliber of thoracic cord remains within normal without detectable abnormal in enhancement.Pre-and post enhanced lumbar MRI:Examination demonstrates very extensive marrow signal changes of the tubercle consistent with diffuse osseous metastatic lesions. There is no evidence of malalignment. There is compression deformity of the superior and inferior endplates of L2 vertebrae however without evidence of marrow space edema to suggest an acute compression. The height of L2 vertebrae at their maximum level of compression measures 14.6-mm and it 27.6-mm height along the dorsal aspect of L2 vertebrae.There is ventral epidural spread of tumor from this tube into the spinal canal and resultant spinal stenosis. No evidence of spinal stenosis at any other level.No detectable signal abnormality or abnormal enhancement of the cauda equina.
1.Pre-and post enhanced MRI of thoracic spine demonstrate extensive osseous metastatic lesions involving the vertebral bodies / posterior elements and with evidence of interval progression since prior exam 1-12-14. No fracture or malalignment. There are multiple foci of epidural spread of tumor noticeably at T11 and T12 with resultant mild central spinal stenosis as detailed above.2.Pre-and post enhanced MRI of the lumbar spine demonstrate extensive osseous metastatic lesions from patient's known lung cancer. There is mild less than 50% compression fracture of the superior and inferior endplates of L2 without detectable marrow space hyperintense signal to suggest edema and likely representing a chronic change. Epidural spread of tumor at the S2 results in central spinal stenosis.