 This exam is limited in the evaluation of multiple myeloma without contrast. THORACIC SPINE: There is slightly heterogeneous T1 signal within the C7 vertebral body that is only partially imaged on this exam. There is an unchanged questionable focus of signal abnormality within the T2 vertebral body. There are minimal degenerate changes including small disc bulges at T5-T6, T6-T7, and T8-T9 without significant spinal canal stenosis. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable. There is an unchanged left-sided perineural cyst at T12 and L1 that narrows the left T12-L1 and L1-L2 neural foramen. LUMBAR SPINE: There is unchanged grade 1 retrolisthesis of L2 on L3 and a slightly worsenned grade 1 anterolisthesis of L5 on S1. There is an infiltrating lesion within the L4 body that was previously hyperintense and on T2 and is now hypointense. There is new T2 hyperintensity within the L2 and L3 vertebral bodies centered at the endplates that is most likely degenerative as well as a non-specific focus of T2 hyperintensity within the L3 vertebral body. There is an unchanged left perineural cyst at the S2-S3. There is a subcentimeter right renal cyst and a left renal cyst that measures approximately 56 mm, previously 35 mm. The vertebral body heights are preserved. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable. There is multilevel disc dessication and disc height loss. L1-L2: There is mild facet arthropathy and ligamentum flavum thickening without significant spinal canal, or neural foraminal narrowing.L2-L3: There is a mild disc bulge as well as facet arthropathy and ligamentum flavum thickening. There is markedly worsened endplate degenerative and disc changes. These findings result in new severe bilateral neural foramen narrowing but no significant spinal canal stenosisL3-L4: There is a mild disc bulge as well as facet arthropathy and ligamentum flavum thickening that results in unchanged severe bilateral neural foramen stenosis but no significant spinal canal stenosis.L4-L5: There is a mild disc bulge as well as facet arthropathy and ligamentum flavum thickening. There is unchanged moderate bilateral neural foramen stenosis and no significant spinal canal stenosis..L5-S1: There is a disc bulge as well as disc uncovering and severe facet arthropathy. There is unchanged mild bilateral neural foramen narrowing and mild spinal canal stenosis.
1.Lesions within the C7 and L4 vertebral bodies are compatible with the diagnosis of multiple myeloma. There are non-specific foci of signal abnormality within the T2 and L3 vertebral bodies. The L4 lesion changes are suggestive of treatment effects. No evidence of acute fracture. 2.Multilevel lumbar spine degenerative changes have somewhat progressed, most prominently at L2-L3, and result in multilevel neural foramen stenosis.3.A large left renal cyst has increased in size and further characterization with ultrasound is suggested.