Neuro_MR_C/T/LS: 58 F, metastatic lung cancer.

MRI CERVICAL, THORACIC, AND LUMBAR SPINE WITH AND WITHOUT CONTRAST:

CLINICAL HISTORY: 55-year-old woman with metastatic lung cancer including leptomeningeal disease treated with CyberKnife and whole brain radiation.

FINDINGS:

Counting from C2, there are five lumbar type vertebral bodies. The last well-formed disc is labeled as L5-S1.

Alignment: Normal.

Bone marrow: Unchanged diffusely heterogeneous bone marrow signal without focal osseous lesion.

Vertebrae: Redemonstrated are degenerative changes most notable in the cervical spine, with broad-based disc osteophyte complexes from C3-C4 through C5-C6 mass effect on the ventral cervical cord, resulting in mild spinal canal stenosis. Multilevel neural foraminal narrowing, without significant change from prior exam, most notable at C5-C6 on the right, moderate to severe. Mild degenerative changes of the lumbar spine, with small annular fissure at L5-S1 and facet arthrosis.

Cord and conus: No abnormal cord signal abnormality or enhancement.

Nerve roots and cauda equina: There is mild increased clumping and enhancement of the cauda equina.

Extra-vertebral soft tissues: Rounded T2 hyperintense enhancing nodule in the right paraspinal soft tissues at the T10 level, measuring 1.5 x 1.3 cm, previously 1.6 x 1.3 cm, no significant change.

Visualized brain: Normal.

Visualized chest, abdomen, and pelvis: Moderate pleural effusion, increased from prior exam. Spiculated mass in the right lower lobe is suboptimally visualized.

Additional comment: None.

IMPRESSION:

1. Increased clumping and enhancement in the cauda equina, consistent with progression of leptomeningeal carcinomatosis.

2. No cord signal abnormality or enhancement.

3. Stable right paraspinal soft tissue mass since 1/19/2015, compatible with nerve sheath tumor.

4. Increase in right pleural effusion, now moderate. Right lower lobe spiculated mass suboptimally evaluated.

(leptomeningeal carcinomatosis)