Multiple myeloma. New right lower extremity paralysis. A limited noncontrast enhanced examination was performed to assess for cord compression.Since the previous examination, there has been decompressive laminectomies (partial at T3, complete at T4-T5) with resection of the intraspinal, extradural posterior component. There is focal T2-hyperintensity in the spinal cord at T4-T5 level which is probably related to previous spinal cord compression.However, new right anterior epidural mass has developed which is an extension from an expansile soft tissue mass that involves the right aspect of T2 vertebral body as well as the paraspinal soft tissue. This mass measures in the axial plane 3.1 cm x 2.8 cm and 2.9 cm craniocaudally. Its intraspinal apical component measures in thickness 7 mm and causes leftward displacement of the spinal cord without definite cord signal abnormality. The intradural component extends from the mid/upper T1 level to the upper most T3 level. The right T2-T3 neural foramen is involved.A similar involvement is present at the L4 level where the vertebral body involvement is associated with an anterior epidural component that measures 9 mm in thickness and mildly to moderately narrows the spinal canal and both L4-L5 neural foramina. While the epidural component has not significantly changed since the previous examination, the remainder of the mass has grown though no axial images are available from the previous examination.There is new soft tissue thickening involving the right L3-L4 neural foramen which does cause mild mass-effect on the thecal sac is well.Central/anterior compression fracture at T12 resulting in about 30% height loss is not significant changed. Diffuse loss of marrow fat signal intensity reflecting replacement remains. There is still STIR hyperintensity involving the T2, T7-T10, L3 and L4 vertebral bodies in addition to the sacral first, third and fourth segments, which may reflect more focal involvement of these levels. The focal fat intensity along the anterior inferior endplate of T7 is unchanged and is probably degenerative in nature.Sacral involvement is predominately right sided and is associated with extraosseous soft tissue that is better assessed on the CT scan from February 15, 2016, which seems to involve the right sacral plexus.
1.Compared to the previous January 7, 2016 MRI, the T4-T5 spinal canal compression has been decompressed. Focal T2-hyperintensity in the spinal cord is probably noted related to previous compression.2.New epidural component related to T2 vertebral body involvement has developed since the previous examination and does displace the spinal cord though without definite signal abnormality in the cord. It does also involve the right T2-T3 neural foramen.3.New soft tissue component involves the right L3-L4 neural foramen including the exiting right L3 nerve root.4.Similar epidural involvement at L4 level has not changed since the previous examination which mildly to moderately narrows the spinal canal and the L4-L5 neural foramina. However, the mass itself has increased in size since the previous examination.5.The right sacral involvement with associated soft tissue thickening along the right sacral plexus/sciatic nerve is better assessed on the CT scan from February 15, 2016 and likely account for patient's right lower extremity weakness.Dr. Monther Qandeel discussed the above findings and recommendations with Dr. Thomas Couri over the phone on 2/16/2016 1:39 PM.