Multiple myeloma, rule-out new bony metastases Cervical Spine: Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate height. There is loss of normal cervical lordosis. Alignment is otherwise maintained. Bone marrow signal is within normal limits. There is a disk extrusion at the C4-C5 level which indents the ventral cord, left greater than right. No associated cord signal abnormality is seen. No significant change based on limited comparison scout view from thoracic MRI dated 9/22/2014. There is a mild disk bulge at the C3-4, 5-C6, and C6-7 levels with partial effacement of the ventral thecal sac. There is minimal right neural foramina narrowing at the C4-C5 and C5-C6 levels. Neural foramina in the cervical spine are otherwise patent.No evidence of suspicious osseous lesions, pathologic compression fractures, or epidural tumor in the cervical spine.Thoracic Spine: Vertebral body heights in the thoracic spine are normal. Alignment is normal. T1 shortening is noted involving the vertebral bodies in the midthoracic spine consistent with history of prior radiation. Compared to 9/22/2014, there is slight interval decrease in size low T1 signal and enhancement involving the posterior superior aspect of the T7 vertebral body on the right extending into the right pedicle, lamina, and transverse process. Lesion measures approximately 2.2 x 3.0 in the craniocaudal and AP dimensions in the sagittal plane, previously 2.2x3.3 cm.Previously seen subcentimeter area of mild enhancement in the dorsal T4 vertebral body is similar, on the sagittal T1 sequence measuring approximately 7x7 mm. No new lesions in the thoracic spine. No evidence of pathologic compression fracture. No epidural tumor.Thoracic cord is normal in signal and caliber. No significant spinal canal or neural foraminal stenosis in the thoracic spine.Lumbar Spine:There are 5 lumbar type vertebral bodies. Vertebral body heights in the lumbar spine are within normal limits. There is grade 1 anterolisthesis of L4 on L5. There is T1 shortening involving the L5 and sacral vertebral bodies consistent with prior radiation.Compared to MRI dated 9/5/2014, there is no significant change in of destructive, enhancing mass involving the right aspect of the sacrum with involvement of the S1, S2, S3 vertebral bodies. There is however decrease in size compared to 12/20/2013 as noted previously. No new lesions in the lumbar spine or visualized sacrum are appreciated. Unchanged increased T2 signal within the right sacral tumor.Mild degenerative changes are seen as below.L1-L2: No significant disk disease. No spinal canal or neural foraminal stenosis. Mild facet arthropathy.L2-L3: Minimal disk bulge. No spinal canal or neural foraminal stenosis. Mild facet arthropathy.L3-L4: Minimal disk bulge. No spinal canal or neural foraminal stenosis. Mild facet arthropathy.L4-L5: Advanced facet arthropathy and mild disk bulge result in mild bilateral neural foraminal narrowing. No significant spinal canal stenosis. Moderate fluid in the left facet joint.L5-S1: Advanced bilateral facet arthropathy, disc bulge, and tumor result in moderate to severe right-sided neural foraminal stenosis similar to prior. Severe narrowing of the right S1-S2 neural foramen related to tumor is also again seen similar to prior.
1. No evidence of disease progression in the spine. No significant change in right T7 and probably tiny T4 lesions. No pathologic compression fractures in the spine or epidural tumor.2. No significant change in size and appearance of visualized destructive right sacral mass with narrowing of the right L5-S1 and S1-2 neural foramina compared to 9/5/2014, although it is much smaller compared to 12/23/2013. Please refer to separate report for additional findings in the pelvis.3. Disc extrusion at the C4-C5 level which indents the ventral cord, left greater than right. No associated cord signal abnormality.