Multiple myeloma. Low back pain and leg weakness. Rule out cord compression. The study is markedly limited by patient motion.COMPLETE SPINE LIMITED:There is loss of the normal fatty signal throughout the marrow. This is associated with mildly increased STIR signal in the lumbar and lower thoracic vertebral bodies, some with coexisting vertebral body compression fractures as described below.While there is no cervical spinal cord compression, there is degenerative disc-osteophyte complex at C5-C6 resulting in mild narrowing of the spinal canal. There is reversal of the normal cervical lordosis which may relate to patient position. The vertebral bodies are preserved in height.In the thoracic spine, there is mild central height loss involving T8 vertebral body with minimal posterior retropulsion but no significant narrowing of the spinal canal. More subtle vertebral body compression fractures are present at T7 and T12. Additionally, there is a small posterior epidural bulge and signal abnormality at T11-T12 and perhaps also at T5 level, which results in minimal to mild spinal canal stenosis but no compression of the spinal cord.LUMBAR SPINE:In addition to the diffuse infiltrative marrow signal abnormality, there is a large, infiltrative presacral soft tissue mass, more pronounced on the right side. This is better assessed on the abdomen/pelvis CT scan from May 28 2016.There is also multilevel central vertebral body compression fractures at all the lumbar levels, most pronounced at L3 where there is about 50% height loss. Multilevel degenerative changes are also present. In the lower lumbar levels, this is combined with posterior epidural soft tissue component at L4 and L5 levels resulting in up to moderate spinal canal stenosis.
1.Markedly limited examination, by patient motion. 2.While there is no definite spinal cord compression or signal abnormality, there is strong suggestion of small posterior epidural soft tissue components at T11-T12 and T5 levels, resulting in minimal to mild spinal canal stenosis.3.In the lumbar spine, there is also posterior epidural soft tissue at L4, L5 and the sacral levels contributing to spinal canal stenosis, up to moderate.4.Infiltrative presacral soft tissue mass is incompletely assessed. However, it involves the lumbosacral plexus roots, especially on the right. This is probably causing or at least contributing to the lower extremity weakness.5.There is also diffuse loss of the normal marrow signal, compatible with a diffuse infiltrative process, multiple myeloma. This is associated with multilevel vertebral body compression fracture, most pronounced in the lumbar spine but no significant retropulsion. The lumbar fractures and T12 fracture are unchanged compared to the previous MRI from 2011 and probably represent chronic osteoporotic fractures.Dr. Monther Qandeel discussed the above findings with Dr. Zainab Abdul-Rahim over the phone on 6/15/2016 11:42 AM. 