Malignant neoplasm of prostate [C61] / Muscle weakness (generalized) [M62.81], Reason for Study: ^Reason: Pt is a 65 y/o male with met CRPC, right leg weakness, evaluate for progression of disease, cord compression History: met CPRC For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. There are replacement of normal fatty marrow of lumbar vertebral bodies, sacrum and bilateral iliac bones with evidence of inhomogeneous enhancement indicating diffuse metastatic lesions.In particular, at the level of L5, there are enhancing soft tissue lesions within the spinal canal out side of thecal sac suggesting tumor extensions. In addition, there are multifocal non enhancing lesions within L5, S1 and bilateral iliac bones indicating necrotic portions.There is also grade 1 anterolisthesis of L4 on L5.Comparing to prior scan performed on Dec 23 2015, there have been interval progression of normal fatty marrow replacement of lumbar vertebral bodies. At the level of L5 and Sacrum, interval development of soft tissue lesions and progression of lower sacral involvement indicate interval progression of metastatic lesions at this level. There is normal lumbar lordosis. Although there are STIR high signal intensities at L4, L5 and S1 vertebral bodies may indicate compression fracture. However, the vertebral body height is preserved. The signal of the visualized cord is normal. The conus medullaris terminates at the L1-L2 level. There is no evidence of abnormal enhancement of spinal cord or cauda equina on this scan.Degenerative changes are specified by the intervertebral level as follows: T12-L1: normal fatty marrow has been replaced, no neuroforaminal narrowing or spinal stenosis. L1-L2: normal fatty marrow has been replaced, no neuroforaminal narrowing or spinal stenosis. L2-L3: normal fatty marrow has been replaced, no neuroforaminal narrowing or spinal stenosis. L3-L4: broad based disc bulging toward left side neural foramen which results minimal to mild neuroforaminal stenosis. No evidence of spinal canal stenosis. L4-L5: pseudo bulging of disc with associated central focal protrusion which abuts thecal sac. There is also associated broad based disc protrusion toward right side neuroforamen which results moderate to severe neuroforaminal stenosis. On Gad enhancement, bilateral ligamentum flavum as well as thecal sac appear to show enhancement indicating possible tumor involvement. Spinal canal at this level also shows mild to moderate stenosis. L5-S1: Diffuse enhancement of sacrum and adjacent soft tissues. In particular, thecal sac at this level also appears to show enhancement.
1. Interval progression of metastatic lesion involvement including lumbar, sacral and bilateral iliac bones since prior scan.2. Grade 1 anterolisthesis of L4 on L5 with moderate degree spinal stenosis.3. Moderate to severe right neuroforaminal stenosis due disc protrusion at the level of L45.4. Bilateral ligamentum flavum and possibly thecal sac enhancements are seen from the level of L5 to sacro-coccygeal area indicate possible tumor involvement of intraspinal content. 5. Spinal cord signal intensity is normal. There is no evidence of abnormal enhancement on spinal cord or cauda equina.