Male, 61 years old, with new right leg numbness and weakness, and pancytopenia. Evaluate for nerve root compression, new or worsening vertebral compression fracture, hematoma or infection/abscess. Patient with history of myelofibrosis status post MUD stem cell transplant. Multiple heterogeneously T2 hyperintense cysts or lobules are seen involving the right sacral ala and right posterior iliac bone. These lesions were not evident on a hip MRI from 6/5/15, and no definite correlating lesions are seen on CT examinations from 8/26/14 or 2/12/2016. The lesions approach but do not appear to frankly encroach upon the sacral foramina.Vertebral body marrow signal is diffusely low on all sequences, findings compatible with myelofibrosis. A small area of fat signal intensity within the L3 vertebral body may represent a focus of presumed fatty marrow or a hemangioma.A compression deformity of the L2 vertebral body is seen with approximately 40% loss of vertebral body height. No marrow edema is detected suggesting that this is a chronic abnormality. The compression is new, however, when compared to a CT examination from 2014. There is mild posterior bowing of the compressed vertebral body, but this causes only mild narrowing of the spinal canal.No other compression deformities are seen. No areas of marrow edema are suspected. Apart from a mild kyphotic angulation centered at the compressed L2 body, spinal alignment is unremarkable.The visualized distal spinal cord, conus and nerve roots of the cauda equina are unremarkable. No epidural fluid collection or pathologic soft tissue process is seen. Prominent dorsal epidural fat is evident from L1 through L4.L1-2: No significant spinal canal or foraminal stenosis. Just below the disc level, posterior osseous bowing or retropulsion does cause mild effacement of the ventral thecal sac. L2-3: No significant spinal canal stenosis or neuroforaminal narrowing. L3-4: Mild facet arthropathy. No significant spinal canal or neuroforaminal stenosis. L4-5: Mild facet arthropathy. Mild disc bulging. No significant spinal canal stenosis. Minimal bilateral foraminal narrowing. L5-S1: Mild facet arthropathy. Mild disc bulging. No significant spinal canal stenosis. Mild left foraminal narrowing.
1.Multiple T2 hyperintense cysts or lobules are evident involving the right sacral ala and right iliac bone. No clear correlating lesions are seen on a recent CT examination from 2/12/2016, nor are any such lesions seen on older MRI examinations from 2015 and 2014. These lesions appear to be confined within the marrow space of the bone and do not significantly encroach upon the sacral nerve roots. One possible explanation is that these lesions represent intraosseous hemorrhage, possibly secondary to bone marrow biopsy or some other mild trauma. Follow-up CT of the pelvis can be considered to reevaluate for osseous integrity. In addition, the patient could return for postcontrast MRI imaging to assess for the possibility, albeit unlikely, of a neoplastic process.2.Bone marrow signal characteristics are diffusely abnormal compatible with patient's diagnosis of myelofibrosis. A moderate compression deformity of the L2 vertebral body is seen, though there is no marrow edema suggesting that it is chronic. No significant epidural pathology is suspected. No high-grade spinal canal or neuroforaminal stenosis is observed.