Expert MRI & CT Second Opinion: Understanding Your Oncology Scan

Report dated: redacted
Patient ID: redacted

CT Head/chest/abdomen/pelvis
MRI lumbar spine

Medical History and Symptoms

Patient with breast cancer underwent mastectomy, radio and chemotherapy. She developed backache. Re-staging.

Patient Questions

1. Does the ‘newly appreciated lucency’ and ‘erosion’ in my spine mean my cancer has returned or spread?

2. My CT report mentioned brain changes like ‘widened sulci’—is this a sign of a neurological issue or a spread of disease to the brain?

3. What is the next step to find out exactly what the spot on my L2 vertebra is, and how urgent is it?

CT staging Findings:

CT head:
Frontal and parietal sulci mildly widened, appropriate for patient’s age. Left ventricle slightly wider than right ventricle – physiological asymmetry. No hydrocephalus or midline shift.

No intra- or extra-axial collection or hemorrhage demonstrated.  No focal abnormality. Grey-white differentiation is preserved.

No bony abnormality demonstrated. The orbits have a normal appearance and the paranasal sinuses and mastoid air cells are clear.

CT chest/abdomen/pelvis:

The heart, great vessels, trachea and oesophagus have a normal appearance. There is no lymphadenopathy. Previous left-sided mastectomy.

The pulmonary vessels and bronchi are normal, as is the pulmonary parenchyma. The pleural spaces are clear.

The liver, spleen, pancreas, adrenals and kidneys have a normal appearance. No cholestasis or hydronephrosis.

The bowel is unremarkable, with normal wall thickness and no faecal loading or dilation.

No free fluid or gas is seen within the abdomen or pelvis. No lymphadenopathy is identified. The vascular structures are normal.

Lumbar scoliosis. Newly appreciated lucency within the L2 superior endplate with cortical erosion. No other focal lesion.

Impression

Newly appreciated bony lesion within the L2 superior endplate, which requires further characterization with MRI lumbar spine. No further suspicious lesions.

MRI lumbar spine Findings:

At the right aspect of the L2 vertebral body just inferior to the endplate is a region of bone marrow oedema, centered on a disrupted and slightly depressed L2 superior endplates with oedema extending into the right pedicle. Postcontrast enhancement is relatively diffuse in this region with normal signal intervertebral disc extending inferiorly, in keeping with a Schmorl’s node. Mild periosteal and paravertebral soft-tissue oedema – reactive. No further focal osseous lesion is identified.

There is no disc herniation or significant stenosis.

No intramedullary or intraspinal lesions. Paraspinal soft tissues demonstrate no gross abnormality.

Impression:

The MRI findings suggest an acute Schmorl’s node at the L2 vertebral body. The imaging findings suggest a structural cause for your back pain. No imaging features are demonstrated on this examination that are typically associated with bony metastases.

Summary for the Patient

The Concern: Because of your medical history, any new bone pain is taken very seriously. Your initial CT scan showed a small “hole” or shadow on one of your lower back bones (the L2 vertebra). In the context of a prior cancer diagnosis, new bone pain appropriately prompts further clinical and imaging assessment to determine whether any features are suggestive of recurrence.

What the Second Look Found: We performed a deep-dive MRI to see exactly what was happening inside that bone. The MRI findings are most consistent with a benign Schmorl’s node rather than metastatic disease.

What is a Schmorl’s Node? Think of it as a small “dent” in the bone caused by the pressure of your spinal disc. It has caused some swelling (oedema) in the bone, which is why your back has been hurting. The imaging findings are most consistent with a benign structural cause rather than a tumour, though we recommend discussing these results with your treating physician.

Your Path Forward: No imaging features are demonstrated at L2 on this examination that are typically associated with active metastatic disease. The imaging findings suggest a structural explanation for your back pain. Discussion of options such as physical therapy or standard pain management may be considered in coordination with your treating physician. The MRI does not demonstrate imaging features typically associated with active metastatic involvement at L2.

Answers to patient questions

“Does the ‘newly appreciated lucency’ and ‘erosion’ in my spine mean my cancer has returned or spread?”
A CT scan is a “screening” tool that can identify changes in bone density, but it cannot always see the internal “signature” of the tissue. Terms like lucency (a dark spot) and cortical erosion (a thinning of the bone’s outer shell) are findings that can be associated with metastasis, but they are also frequently caused by benign structural issues. In your case, the follow-up MRI was essential because the MRI findings suggest that the CT ‘erosion’ corresponds to a Schmorl’s node —a non-cancerous indentation where the spinal disc has pressed into the bone. It is a structural change.

“My CT report mentioned brain changes like ‘widened sulci’—is this a sign of a neurological issue or spread to the brain?”
Widened sulci and ventricular asymmetry are very common findings that we consider “physiological,” meaning they are a normal part of the aging process. The report explicitly states that your grey-white differentiation is preserved and there are no focal abnormalities. The structure of your brain and the way different tissues appear on the scan are consistent with what we expect to see at your current age.

“What is the next step to find out exactly what the spot on my L2 vertebra is, and how urgent is it?”
Given your oncologic history, new findings are evaluated with heightened clinical attention. The CT scan provided the “where,” but the MRI Lumbar Spine provided the “what.” MRI is particularly sensitive for evaluating bone marrow signal characteristics. The MRI findings are most consistent with an acute Schmorl’s node with localized oedema.
Based on current imaging, the L2 finding appears structurally mediated rather than oncologically driven. The imaging findings suggest a benign structural cause for your back pain rather than features concerning for metastatic disease. Management options such as consultation with a spine specialist or physiotherapist may be considered in coordination with your treating physician. From an oncologic imaging perspective, the MRI does not demonstrate imaging features typically associated with aggressive metastatic disease.