Clinical portion: Multiple myeloma, history of T4 compression fracture and a skeletal survey showed multiple lytic lesions. Follow up exam. Signs and symptoms: As above. Nonenhanced cervical MRI:Examination demonstrates multiple tiny foci of marrow signal changes without appreciable interval change since prior study and suspect that all multiple myeloma. There is no evidence of fracture and the alignment of the column is anatomical. Foramen magnum is unremarkable.C2 -- C3 demonstrate minimal degenerative changes and unremarkable otherwise.C3 -- C4 demonstrate moderate disk disease and loss of disk height with interval worsening since prior exam. There is asymmetrical left-sided uncal acute hypertrophy changes resulting in moderate to severe left neural foraminal compromise without central spinal stenosis.C4 -- C5 demonstrate mild disk disease with mild right neural foraminal compromise and no central spinal stenosis.C5 -- C6 demonstrate moderate disk disease and loss of disk height without evidence of spinal stenosis or neural foraminal compromise.C6 -- C7 demonstrate moderate disk disease and loss of disk height no significant change since prior exam. Mild bilateral neural foraminal compromise without significant change since prior study and no central spinal stenosis.C7 -- T1 is unremarkable.Nonenhanced thoracic MRI:Examination redemonstrated findings of multiple myeloma of the thoracic spine primarily at T4, T5 and T6 levels and minimally at other levels without evidence of any significant change. There is no convincing evidence of any new lesion since prior exam.Significant compression deformity and flattening of T3 vertebrae without malalignment or spinal stenosis demonstrate no significant change since prior exam.Mild wedged shaped compression deformity of T4 and with associated marrow signal abnormality without malalignment or spinal stenosis demonstrate no convincing evidence of interval change.Patchy diffuse marrow signal changes of vertebral body or T6 without fracture or malalignment or interval change since prior study.There is very subtle depression of the superior endplate of T7 without associated marrow signal changes is a new finding since prior exam.Demarcated round foci of marrow signal changes in the vertebral body of T8 and T12 consistent with hemangiomas remains stable since prior study.No evidence of spinal canal compromise at any level is detected.No evidence of neural foraminal compromise at any level.Normal signal intensity and caliber of thoracic cord.Nonenhanced lumbar MRI:Examination demonstrate tiny foci of marrow signal replacement consistent with multiple myeloma with altered interval change since prior exam. The findings are identified in the vertebral body of L2, L4 and punctate foci in the other levels.The alignment of the vertebral column remains within normal and without evidence of spinal stenosis at any level. There is also no evidence of neural foraminal compromise at any level. Mild to moderate bilateral ligamentum flavum hypertrophy at the L3 -- 4 and L4 -- L5 levels are identified.
1.Examination of the cervical spine demonstrate stable few tiny foci of marrow signal change suggestive of multiple myeloma. Slight interval progression of degenerative changes of cervical spine however without resultant central spinal stenosis at any level. Multilevel neural foraminal compromise as detailed per level above. Normal signal intensity and caliber of the cervical cord.2.Examination of thoracic spine demonstrate no evidence of any new lesions since prior study. Stable significant compression fracture of T4 and mild wedge compression deformity of T5 demonstrate no appreciable interval change since prior study. Diffuse marrow signal changes of the T6 vertebral body without fracture consistent with multiple myeloma remain stable since prior exam. No malalignment and no evidence of spinal canal or neural foramina compromise at any level. 3.Examination of the lumbosacral spine minimal findings of multiple myeloma without interval change since prior exam. Normal anatomic alignment the vertebral column and without evidence of central spinal or neural foraminal stenosis.