Clinical question: Evaluate for myelomatous lesions. Signs and symptoms: Known myomatous lesion in pelvis; 8 unsteadiness. Pre-and post enhanced cervical MRI:The examination demonstrates a focus of marrow signal T2 stair hyperintensity and hypointensity on T1 in the anterior body of C6 measuring approximately 9 mm in size. The finding also demonstrate enhancement on post infused images and is concerning for a metastatic myomatous lesion.There is a tiny focus of enhancement along the inferior endplate of C4 consistent with a tiny Schmorl's node.Degenerative changes of cervical spine results in mild central spinal stenosis at C2 -- C3, moderate central spinal stenosis at C3 -- C4, moderate to severe central spinal stenosis at C4 -- C5 , C5 -- C6 levels and mild central spinal stenosis at C7 -- T1 level. Degenerative changes also results in multilevel neural foraminal compromise. There are mild to moderate bilateral (right greater than left) neural foraminal compromise at C3 -- C4, moderate right and mild left neural foraminal compromise at C4 -- C5, significant bilateral neural foraminal compromise at C5 -- C6 and C6 -- C7 levels.The signal intensity of the cervical cord remains within normal and without abnormal enhancement.Pre-and post enhanced thoracic MRI:There is normal anatomical alignment the vertebral column. There is mild exaggeration of lumbar lordosis centered at approximately T7 level.There is a well-demarcated focus of T1 and T2 hyperintensity which demonstrate hyperintensity signal pattern on T2 stir and without evidence of enhancement. The finding is consistent with a focus of fatty deposit of no clinical significance.There is no detectable foci of signal abnormality of vertebral column or abnormal enhancement to suggest metastatic disease.The signal intensity and caliber of thoracic cord remains within normal and without abnormal enhancement.There is no evidence of spinal canal compromise or stenosis at any level.There is no evidence of neural foraminal compromise at any level. Mild degenerative changes including ligamentum flavum hypertrophic changes at multiple levels is noted.Pre-and post enhanced lumbar MRI:The signal intensity of vertebral column demonstrate subtle changes secondary to degenerative disease and unremarkable otherwise in particular for evidence of metastatic lesions. There is no detectable abnormal enhancement the vertebral column.The signal intensity of conus and cauda equina is also within normal and without abnormal enhancement.There is generalized smaller caliber of lumbar spinal canal which is believed to be at least partially secondary to congenital anatomical variation.L1 -- L2 demonstrate moderate disk disease and ligamentum flavum hypertrophy changes. There is a small left paramedian disk/osteophyte complex present. There is no central spinal stenosis or neural foraminal compromise.L2 -- L3 demonstrate mild disk disease and moderate to severe bilateral ligamentum flavum hypertrophy and mild hypertrophy changes of facets. Constellation of degenerative changes in combination with congenitally smaller canal at this level results in mild central spinal stenosis however without neural foraminal compromise.L3 -- L4 demonstrate moderate disk disease and loss of disk height, moderate bilateral ligamentum flavum hypertrophy and mild bilateral facet hypertrophic changes. There is a tiny right lateral shallow broad-based disk protrusion at this level present.Constellation of above findings results in significant central spinal stenosis at this level and no neural foramina compromise.
1.Pre-and post enhanced MRI of cervical spine demonstrate a single 9-mm focus of marrow signal change and enhancement in the body of C6 vertebrae which is nonspecific however considering patient's history could represent a focus of metastatic myomatous lesion. No additional foci of abnormal enhancement of vertebral column or enhancement of the cord to suggest malignancy. There are extensive degenerative changes of cervical spine with multilevel central spinal stenosis (most significantly at C5 -- C6) and multilevel bilateral neural foraminal compromise (some significantly as detailed per level above.2.Pre-and post enhanced MRI of thoracic spine is unremarkable.3.Pre-and post enhanced MRI of lumbar spine demonstrate no evidence of metastatic disease. There is congenitally smaller caliber of the spinal canal. This finding in combination with degenerative changes results in significant central spinal stenosis at L3 -- L4 level and to a lesser degree at L2 -- L3. No significant neural foraminal compromise. Please see above comments.