Stage IV scan results, need your input please!

Hi everyone,

I don't usually post, I'm more of a reader but I've run into an issue with my scan results. I'm a stage IV patient, dx initially in 2001 as a stage III. I had lung mets in 2015 which were resected and I followed up with 3 ipi infusions (never made it through my fourth as I developed colitis).

I've beeen NED since Jan 16 but went to my onc last week with some troubling issues – confusion, problems with my short-term memory, numbness in both arms from my elbow down into my pinky and ring fingers. I have back pain all the way from my mid-back down to my lumbar region and my body twitches on occasion. 

My onc sent me to the ER to get an MRI because it would be the fastest way to get results. The good news is that my brain looks fine. The bad news is that my spine has multiple lesions (looks like at least 6). My oncologist doesn't think that the lesions are melanoma – she's suggesting congenital or trauma. But I'm a little leery of her conclusion. From 2013 to 2015 we watched my metastatic lung nodes grow slowly, during which time she was convinced that they were benign granulomas.

I really love my onc and have been with her for nearly 20 years; she has the best bedside manner of anyone in the business. But her strategy is to be non-alarmist and I fear that she's holding back on me until we have further evidence of growth. I had a CT of my chest, abdomen and pelvis last week and all was clear. I'm at NYU and thinking of getting a second opinion at Sloan re: my spine; any thoughts from the board would be appreciated.

Best,

Jessica

Study Result

IMPRESSION:

Slight interval increase in size of an enhancing, sclerotic subcentimeter lesion within the T1 vertebral body, suspicious for metastatic disease.
Additional 5 mm T7 superior endplate enhancing lesion, not definitively seen on the prior study, suspicious for metastasis.
Additional small enhancing lesions within L1 and L3 vertebrae may represent additional foci of metastatic disease.
Multiple other indeterminate vertebral body lesions as described above.
No evidence of cord compression or epidural extension of neoplasm.
Narrative
Clinical history: Metastatic melanoma, presenting with right upper extremity radiculopathy and 2-4 weeks of confusion

Technique: MRI examination of the entire spine was performed prior to and following administration of 5 cc Gadavist intravenous contrast.

Comparison: MRI of the cervicothoracic spine from 12/9/2015. Comparison is made to multiple CT examinations of the chest, most recent from 7/13/2017

Findings:
Alignment throughout the cervical, thoracic and lumbar spine is maintained without evidence of listhesis. Vertebral body heights are preserved without evidence of acute compression deformity.

There is a 9 x 8 mm homogeneously T1 hypointense, heterogeneously T2/STIR hyperintense, predominantly peripherally enhancing lesion within the T1 vertebral body. This lesion appears sclerotic on multiple prior chest CTs. Compared to the prior MRI given differences in technique, it appears slightly larger, previously measuring possibly 6 x 5 mm.

There is additionally a 5 mm T1 hypointense, T2/STIR hyperintense enhancing lesion within the T7 superior endplate. It was not definitely seen on the prior examination.

There is redemonstration of a T1/T2 hypointense, well-circumscribed sclerotic lesion within the left aspect of the C7 vertebral body, unchanged from prior examinations, and likely representative of a bone island. No associated enhancement is seen.

Unchanged from the prior MRI is a nonspecific 7 mm STIR hyperintense lesion within the right facet of T2.

There is an indeterminate, peripherally STIR hyperintense/enhancing lesion within the right T4 facet is noted.

There is a 7 mm T1 hypointense, STIR hyperintense enhancing lesion within the L1 vertebral body. Additional questionable STIR hyperintense, possibly enhancing lesion measuring 6 mm within the L3 vertebral body.

Evaluation of the cervical spine demonstrates no significant disc herniation, cord compression or neural foraminal narrowing.

There are scattered mild degenerative changes throughout the thoracic spine. Visualized on sagittal images only, there is a right central disc herniation at T7-8 which appears to contact the ventral cord, with mild resultant canal stenosis.

Evaluation of the lumbar spine on sagittal images demonstrates no large disc herniation, significant canal or neural foraminal stenosis.

There is no signal abnormality identified within the spinal cord. No abnormal cord or intrathecal enhancement is seen. The conus medullaris terminates at the superior L2 level and is unremarkable in appearance.