Clinical question: S1 left sciatica pain. Right lower thorax pain. History of T5 plasmacytoma status post RT. Unenhanced thoracic MRI:There is normal anatomical alignment the vertebral column however with mild exaggeration of thoracic kyphosis. There is diffuse marrow signal replacement involving vertebral body of T5 and the pedicles as well as the scan 50% compression deformity. The signal changes of T5 vertebrae consists of T1 hypointense, T2 hyperintense and more noticeably T2 stir hyperintensity. The finding is consistent with patient's known history of T5 plasmacytoma. There is no detectable associated epidural or paraspinal soft tissue abnormality with the findings and the alignment remains feeding normal. No spinal stenosis or neural foraminal compromise at this level.Marrow signal changes in a uniform fashion involving vertebral bodies of T2 through T7 which consists of T1 hyperintense and T2 slightly hyperintense and T2 stir hypointense consistent with postradiation changes.There are numerous varying size however very small foci of T2 stir hyperintensity involving the tuber bodies and the posterior elements all thoracic spine most severely at T9 through T12 which are highly suspected of representing additional foci of tumor. There is mild epidural thickening posterior to the vertebral body of T11 resulting in subtle mass effect and posterior displacement of the thecal sac. There is also slight anterior bulge of thecal sac posteriorly secondary to significant ligamentum flavum hypertrophy at T10 -- T11 level. To entirely exclude epidural spread of tumor at this level post enhanced imaging is recommended. There is normal signal intensity and caliber thoracic cord.Nonenhanced lumbar MRI:There is normal anatomical alignment the vertebral column.There is diffuse patchy foci of T2 stir hyperintensity throughout the lumbosacral spine highly suggestive of metastatic foci. No fracture or malalignment is detected. No detectable epidural or paraspinal associate soft tissue abnormality with the above findings.T12 -- L1 is unremarkable.L1 -- 2 is unremarkable.L2 -- L3 is unremarkable.L3 -- L4 demonstrate mild disk disease, shallow broad based bulging disk and mild bilateral facet and ligamentum flavum hypertrophy. Mild central spinal stenosis and moderate bilateral neural foraminal compromise is present.L4 -- L5 demonstrate mild to moderate disk disease and loss of disk height, moderate bilateral facet and ligamentum flavum hypertrophy. There is widening of bilateral facets spaces containing fluid signal intensity which could represent synovitis or possibly fusion. In addition a small synovial cyst projects within the left ligamentum flavum with resultant further mass effect on the thecal sac. This finding measures approximately 6.5 mm in longest axis (axial T2 series 15 image 18). Constellation of above findings results in mild to moderate central spinal stenosis, significant left and moderate right neural foraminal compromise. At L5 -- S1 demonstrate mild disk disease and loss of disk height and mild bilateral facet and ligamentum flavum degenerative changes. Minimal bilateral facet effusion is present. No spinal stenosis or neural terminal compromise.
1.Nonenhanced MRI of thoracic spine demonstrate mild compression deformity of T5 vertebrae with diffuse marrow signal changes and consistent with patient's known plasmocytoma. Uniform marrow signal changes from T2 through T7 representing prior radiation therapy. Numerous small foci of T2 stir hyperintensity throughout the thoracic spine highly suspected of additional foci of tumor deposit. Subtle epidural thickening along the ventral aspect of the canal at T11 level could represent epidural spread of tumor and follow up with enhanced imaging is recommended.2.Nonenhanced MRI of the lumbar spine demonstrate numerous small varying sized foci of T2stir hyperintensity highly suspected of tumor deposits. No fracture or malalignment. Degenerative changes at L4 -- L5 and including a left-sided ligamentum flavum centered synovial cyst results in mild to moderate central spinal stenosis and neural foraminal compromise as detailed above.