Smoldering multiple myeloma. Assess for myelomatous involvement. THORACIC SPINE: There is multilevel degenerative cervical spondylosis that is better assessed on the recent cervical spine MRI, including minimal anterior subluxation of C7 relative to T1. Otherwise, the thoracic sagittal alignment is preserved. The vertebral body heights are preserved. Mild multilevel degenerative disc desiccation and height loss are most pronounced at T10-T11, where a small posterior central disc protrusion mildly narrows the spinal canal. There is also a small right foraminal disc protrusion along with right facet arthropathy resulting in mild T10 and T11 right neural foraminal stenosis. There is no other significant spinal canal stenosis. The vertebral bone marrow signal is unremarkable, accounting for mild degenerative signal anteriorly and T5-T6 and T10-T11. The spinal cord displays normal signal and morphology. There is no abnormal contrast enhancement. Apparent contrast enhancement in T7-T8 disc probably represents intrinsic T1 shortening rather than real enhancement. The esophagus is patulous. The paravertebral soft tissues are unremarkable.LUMBAR SPINE: There is a leftward convex curvature. Sagittal alignment is relatively preserved. The vertebral body heights are preserved. While the intrabody herniation in the inferior L1 has not changed, new intrabody herniations have developed at L2-L3 associated with mild subjacent contrast-enhancing marrow edema. This is associated with increased right-sided L2-L3 disc height loss and increased posterolateral, paracentral disc bulge resulting in left subarticular recess stenosis and moderate left neural foraminal stenosis while the mild right neural foraminal stenosis is unchanged. Otherwise, the vertebral bone marrow signal remain heterogeneous but without significant focal lesion. Focal contrast enhancement subjacent to the superior L3 endplate on the right correlates with small focal T2-hyperintensity, which is unchanged since the prior examination. The other levels show unchanged disc desiccation and height loss. The mild central and left paracentral canal stenosis at L3-L4 are unchanged, as well as the mild bilateral neural foraminal stenoses. Lower lumbar facet osteoarthritic changes along with small joint effusions are present. There is no significant spinal canal stenosis. The conus medullaris displays normal signal and morphology and its tip lies at lower L1 level. Heterogeneous pelvic marrow signal is not significantly changed from the prior MRI of May 17, 2016 and probably reflect posttreatment findings.
1.Thoracic spine: No definite myelomatous involvement in the thoracic spine. Mild multilevel degenerative spondylosis but no significant spinal canal stenosis or cord compression. Apparent contrast enhancement in T7-T8 disc probably represents intrinsic T1 shortening rather than real enhancement. 2.Lumbar spine: No definite myelomatous involvement in the lumbar spine. Multilevel degenerative spondylosis is most pronounced at L2-L3, where increased posterolateral, paracentral disc bulge results in left subarticular recess stenosis and moderate left neural foraminal stenosis. There has not been significant change of the multilevel spondylosis otherwise. 3.Heterogeneous pelvic marrow signal is not significantly changed from the prior MRI of May 17, 2016 and may reflect treatment effects. Please refer to the recent pelvis MRI for additional details.4.The esophagus is patulous, which may be associated with gastroesophageal reflux. 