Clinical question: Smoldering multiple myeloma. Rule out bone lesions. Signs and symptoms: As above. Nonenhanced cervical MRI:Examination demonstrates normal anatomical alignment of vertebral column however with mild straightening of cervical lordosis.There is no detectable foci of marrow signal replacement to suggest multiple myeloma. There is normal signal intensity and caliber of the cervical cord.Moderate disc disease and loss of disc height and mild facet and ligamentum flavum hypertrophy at C5-C6 resulting in moderate bilateral neural foraminal compromise and mild central spinal stenosis. Degenerative changes at C6-C7 results in mild bilateral neural foraminal compromise and no central spinal stenosis.Nonenhanced thoracic MRI:Examination demonstrates a focus of T1 hyperintense, T2 hypointense and minimally T2 STIR hyperintense involving the dorsal aspect of vertebral body of T4 and extending into the left pedicle and left inferior facet. The signal changes of the findings are suggestive of a focus of fatty deposit or a capillary hemangioma. There is no evidence of destructive changes of the bone. Follow-up with CT is recommended for further assessment.The signal intensity and the alignment of the vertebral column is otherwise within normal and without finding to suggest multiple myeloma. The signal intensity and caliber of the thoracic cord is within normal. There is no evidence of spinal canal or neural foraminal compromise/stenosis at any level.Nonenhanced lumbar MRI:There is no detectable focus of signal abnormality of the vertebral column to suggest multiple myeloma.There is a well-demarcated round focus of T1 hyperintense, 2 hyperintense and minimally hyperintense on T2 STIR in the left lateral aspect of L1 vertebrae. On axial T2 weighted images there are multiple tiny internal foci of hyperintensity within this finding which is suggestive of a skeletal capillary hemangioma.The alignment and signal intensity of vertebral column is otherwise unremarkable. Mild degenerative changes of the lumbar spine are noted however without evidence of spinal stenosis or definitive neural foraminal compromise at any level. Mild facet effusion on the left at L4-L5 is noted.
1.Nonenhanced MRI of cervical spine demonstrate no evidence of multiple myeloma. Degenerative changes at C5-C6 and C6-C7 level with resulting mild central spinal stenosis and neural foraminal compromise as detailed above. Normal signal intensity and caliber of cervical cord.2.Nonenhanced MRI of thoracic spine demonstrate a well-demarcated focus of T1 hyperintense, T2 hyperintense and minimally hyperintense T2 and STIR involving dorsal aspect of the vertebral body of T4 and left pedicle/articulating facet highly suggestive of a hemangioma. Unremarkable exam otherwise and without convincing evidence of multiple myeloma.3.Nonenhanced MRI of lumbar spine demonstrate a round well-demarcated focus of marrow signal replacement highly suggestive of a capillary skeletal hemangioma and unremarkable otherwise for multiple myeloma. Mild degenerative changes however without spinal stenosis or convincing evidence of neural foraminal compromise.