Female, 80 years old, with back pain and fever, known vertebral body lesions. Patient is status post biopsy of the T10 and L4 vertebral bodies which did not, however, provide a definitive diagnosis. Thoracic:Heterogeneous marrow signal likely representing a combination of edema and sclerosis is seen involving the T4-T8 vertebral bodies, and the T4-5 intervertebral disc. These structures also demonstrate patchy heterogeneous enhancement.There may be mild loss of vertebral body height at T7-T8, but elsewhere heights are preserved. The T7-8 intervertebral disc is reduced in height and also demonstrates enhancement. The other involved disc spaces seem relatively preserved.Note is made of thickened enhancing tissue in the right anterior paraspinal space beginning at T4 and continuing down to T8. Minimal ventral epidural thickening is also seen at T7 and T8. No rim-enhancing collections are demonstrated.At T9 and T10, marrow signal is seen most compatible with sclerosis. Significant edema and enhancement are absent.There are technical differences between the present examination and the prior examination, but accounting for this, the overall pattern and distribution of these findings is similar to prior.A dextroscoliosis of the thoracic spine is redemonstrated. Sagittal alignment is unremarkable. Spinal cord signal characteristics are unremarkable. No large disc herniations are seen. No significant compromise of the spinal canal or neural foramina is suspected.Lumbar:Edema within the L3 and L4 vertebral bodies and the intervening disc space has progressed when compared to the prior examination. These structures also demonstrate diffuse heterogeneous enhancement. Furthermore, the anterior and lateral paraspinal soft tissues are thickened and enhancing, but no discrete fluid collections are seen. Edema and enhancement are noted within the posterior elements of L5, new from prior. The soft tissues surrounding the spinous process at this level are also thickened and enhancing.Vertebral body heights are preserved. No other definite marrow edema or pathologic marrow enhancement is seen. Spinal alignment is anatomic.Image quality is degraded by motion artifact, but within this limitation, the distal spinal cord and cauda equina are unremarkable, except as discussed by level below.L1-2: Loss of disc height, mild endplate irregularity, and disc bulging. No significant spinal canal stenosis. Mild right foraminal narrowing. L2-3: Disc bulging, asymmetric to the right foraminal and far lateral zones. No significant spinal canal stenosis. Mild right foraminal narrowing. L3-4: Mild facet hypertrophy. Disc bulging. Mild spinal canal narrowing without cauda equina impingement. No significant foraminal narrowing. L4-5: Facet hypertrophy. Disc bulging with a right paracentral disc protrusion. Moderate generalized spinal canal narrowing with particular effacement of the right ventral thecal sac and the right lateral recess. Mild bilateral foraminal narrowing. L5-S1: Facet hypertrophy. Mild disc bulging. No significant spinal canal stenosis. Mild left foraminal narrowing.
Multiple vertebral bodies in the thoracic and lumbar spine demonstrate characteristics compatible with mixed edema and sclerosis. Edema and enhancement is also seen in scattered disc spaces as above. These findings appear relatively unchanged in the thoracic spine, but they have progressed at L3 and L4 in the lumbar spine.In both the thoracic and lumbar spine, the anterior and lateral paraspinal soft tissues adjacent to the affected vertebral bodies demonstrate thickening and enhancement compatible with inflammation. Edema and enhancement is also seen within and adjacent to the posterior elements of L5.The differential diagnosis for these findings would include a chronic smoldering osteomyelitis, or less likely an inflammatory arthritis. A neoplastic etiology is not entirely excluded, though this is also felt to be less likely.