Clinical question: Follow-up S1 lesion, status post SCT. Signs and symptoms: Left S1 radiculopathy. Pre and post enhanced lumbar MRI:Lower most visualized thoracic spine from T9 inferiorly demonstrate extensive postoperative changes including posterior bilateral transpedicular screw placement at T9, T10, T12 and L1 levels. Extensive artifacts from metallic hardware precludes precise assessment for pathology in this region. There is mild kyphotic deformity centered at L1 vertebrae which appears to be less than compressed. Mild central spinal stenosis at T10 and T11 level is suspected.T12-L1 demonstrate mild disc disease with loss of disc height, mild chronic compression deformity of the superior endplate and unremarkable exam otherwise.L1-L2 demonstrate mild disc disease and loss of disc height, mild chronic compression deformity of superior endplate and a Schmorl's node along the superior endplate. No spinal stenosis or neural foraminal compromise.L2-L3 demonstrate mild disc disease and loss of disc height, mild bilateral facet and ligamentum flavum hypertrophy with resultant mild central spinal stenosis and no neural foraminal compromise.L3-L4 demonstrate mild disc degeneration and loss of disc height, moderate ligamentum flavum and mild bilateral facet hypertrophy. Mild central spinal stenosis without neural foraminal compromise is noted.L4-L5 demonstrate moderate disc disease and loss of disc height, moderate bilateral ligamentum flavum and to a lesser degree facet hypertrophy changes are present. No spinal stenosis however moderate right neural foraminal compromise is identified.L5-S1 demonstrates advanced disc disease and loss of disc height, mild grade 1 retrolisthesis, mild bilateral facet and ligamentum flavum hypertrophy. No spinal stenosis however moderate left and mild right neural foraminal compromise is present.There is a large metal demarcated focus of T1 hypointense and T2/T2 STIR hyperintense signal intensity in the left posterior body of S1 and left pedicle and sacral ala measuring at approximately 25 x 32 mm in transaxial dimensions. The findings demonstrate enhancement and highly suspected of a focus of multiple myeloma considering patient's history. The finding abuts the left S2 nerve root canal however without evidence of extension into the neural foraminal or mass effect on the nerve root. No fracture and no evidence of extraosseous soft tissue enhancement.
1.Well-demarcated focus of T1 hypointense, T2/T2 Stir hyperintense enhancing mass in the left posterior S1 vertebral body, pedicle and sacral ala suggestive of a metastatic multiple myeloma. No extraosseous spread of tumor.2.Mild central spinal stenosis secondary to degenerative disease at L2-L3 and L3-L4 levels.3.Neural foraminal compromise as detailed per level above.4.Extensive postoperative changes of posterior fusion extending from T9 through L1 with extensive metallic hardware artifact which precludes precise assessment. Within this limitation however mild central spinal stenosis at T10 and T11 is suspected.