Multiple myeloma with new neck pain and known compression fractures, thoracic pain and tumor at T5- now bilateral rib pain radiating bilaterally from T5. Evaluate for disease or compression fracture progression. Cervical: Lack of contrast limits assessment for small lesions. There is diffuse infiltration involving the C5 vertebral body compatible with myelomatous involvement. There is subtle soft tissue thickening dorsal to the C5 vertebral body suspected to represent epidural tumor, and new since prior study from 4/14/2015. There is moderate spinal canal stenosis at this level which is predominantly on a degenerative basis including disc osteophyte complex and ligamentum flavum thickening. The moderate spinal canal stenosis at the C4-C5 and C5-C6 levels which is minimally worse given the now suspected thin epidural tissue. No cord signal abnormality is evident. There also appears to be mild to moderate C5-C6 neural foraminal stenosis, particularly on the right related to combination of degenerative disease/uncovertebral hypertrophy and epidural tumor.There are minimal degenerative changes elsewhere in the cervical spine without spinal canal or neural foraminal stenosis. No evidence of compression fractures in the cervical spine. Bone marrow signal heterogeneity including T1 hyperintensity involving the anterior aspect of the upper cervical vertebral bodies may represent sequela of prior treatment and similar to prior. No new cervical lesion is appreciated within the limits of noncontrast study.Thoracic:There are multiple compression fractures throughout the thoracic spine, essentially affecting all vertebral bodies aside from T4 and T12. There is severe compression fracture with approximately 70% loss of height involving the T6 vertebral body which appears slightly worse in the interval. Evidence of prior cement augmentation noted involving multiple thoracic vertebra. There is focal effacement of the ventral thecal sac at multiple levels including T8 and T10 which appears to be related to chronic cement extravasation. No high-grade spinal canal stenosis at any level or thoracic cord signal abnormality. Mild neural foraminal stenosis is present in multiple levels related to degenerative disease without high-grade neural foraminal stenosis at any level.There is exaggerated thoracic kyphosis with apex at the T6 level, similar to prior. Previously seen epidural tumor at the T6 level appears to have resolved. No new site of epidural disease is appreciated within the limits of noncontrast study.There is an approximately 16 mm lesion involving the T4 vertebral body which appears more discrete/larger than prior. Additional scattered small lesions seen previously are difficult to assess; no new large lesions are evident.There is diffuse osteopenia more evident on recent radiographs. Partially imaged lumbar spine also demonstrates a mild compression fracture of L1 and present previously without associated spinal canal stenosis.There is mild deformity involving the posterior medial aspects of the right 8th through 10th ribs likely related to remote fractures. Abnormal marrow signal involving multiple ribs consistent with myeloma.
1. Please note lack of intravenous contrast limits evaluation for small lesions including small foci of epidural tumor. Again seen is evidence of multiple myeloma affecting the cervical and thoracic spine. Compared to examination from 4/14/2015 there appears to be increased, thin soft tissue dorsal to the C5 vertebral body suspected to represent new epidural tumor. There is moderate spinal canal stenosis at this level, primarily on a degenerative basis but appears slightly worse in the interval secondary to the increased epidural tumor. No evidence of frank cord compression or cord signal abnormality.2. Previously seen epidural tumor at the T6 level is no longer appreciated. No new site of epidural disease in the thoracic spine within the limitations of noncontrast study.3. Increased size of lesion involving the T4 vertebral body without associated compression fracture or spinal canal stenosis.4. Multiple thoracic as well as L1 compression fractures, worst at the T6 level where there is approximately 70 % loss of height, which is slightly worse in the interval. Evidence of prior cement augmentation of T7-T10 evidence of chronic extravasation dorsally into the ventral epidural space appearing unchanged. No evidence of high-grade spinal canal stenosis in the thoracic spine or cord signal abnormality.5. Multiple osseous lesions elsewhere including the ribs and sternum are better appreciated on recent chest CT. Mild deformity involving the posterior medial right 8-10th thoracic ribs are compatible with remote fractures.