MRI whole spine
Treatment with surgery, chemotherapy, radiotherapy. Deterioration.
Findings:
There has been marked progression of leptomeningeal metastatic disease.
At the cervical cord there is extensive enhancing extramedullary tumour encasing and compressing the spinal cord between C2 and T1 vertebral levels over distance of 11.5 cm. This distorts and compresses the cord at multiple levels, most marked at the level of C1/2 where a component of the tumour measuring 0.9 x 1.1 x 1.2 cm bulges significantly into the cord from the right posterolateral cord surface and causes marked compression of the cord parenchyma (to under 3 mm in thickness). No preexisting intramedullary enhancing lesion is identified at this location.
There is patchy abnormal increased T2 signal throughout the cervical cord.
There has been increase in the size of the lobulated extramedullary disease at the conus and cauda equina.
A lobulated enhancing mass measuring 9.7 cm in craniocaudal length encases the distal cord, conus and upper aspect of the cauda equine between levels of T11/12 and L2/3. This has progressed from the previous identified 2 x 1.2 x 2.3 cm ovoid extramedullary lesion previously present.
Small nodules throughout the cauda equina spinal nerve roots are again demonstrated.
Decompressive laminectomy from T1-T3 is again demonstrated. Myelomalacia and dorsal cord tethering again noted.
Extensive marrow signal changes in keeping with previous radiotherapy again demonstrated.
Impression:
Marked progression of leptomeningeal metastatic disease with encasement of almost the entire cervical cord, resulting in marked cord compression and oedema.
Further marked disease progression with compression at the conus and cauda equina.