Female, 61 years old, with relapsed multiple myeloma and concern for new plasmacytoma. Cervical:Spinal alignment is anatomic. Vertebral body heights are preserved. Marrow signal characteristics are slightly heterogeneous. However, no focal STIR hyperintense or enhancing lesions are seen. The visualized spinal cord is within normal limits. The intervertebral discs are preserved. No significant compromise of the spinal canal or neural foramina is seen. Several mildly prominent and enhancing lymph nodes are seen in the left neck at level II. The left thyroid lobe is enlarged and heterogeneous.Thoracic:Exaggeration of the thoracic kyphosis is seen. Multiple thoracic spine compression deformities are noted including T6, T10, T11 and T12, showing no significant interval change. Marrow signal characteristics are heterogeneous but without focal STIR hyperintensity or pathologic enhancement. The visualized spinal cord is within normal limits. Mild disc bulging is seen at several levels but at no level is there any significant spinal canal or foraminal compromise.Lumbar:A compression deformity of the L1 vertebral body with evidence of kyphoplasty is redemonstrated showing no significant interval change. Mild retropulsion of vertebral body material causes mild effacement of the ventral thecal sac.Superior endplate cavity is seen at L3 with mild associated T1 hypointense marrow signal but no evidence of STIR hyperintensity or pathologic enhancement. However, an area of marrow replacement and pathologic enhancement is seen within the right sacral ala measuring 3 to 4 cm in diameter. This lesion abuts and may infiltrate the right S1 neural foramen.Nonspecific enhancement is seen along and within the left SI joint. No other focal enhancing lesions are detected.The visualized distal spinal cord, conus and cauda equina are within normal limits.At L1-2, there is mild effacement of the ventral thecal sac and mild foraminal narrowing due to vertebral body retropulsion. At the remaining lumbar levels only minimal disc bulging is seen. However, facet arthropathy becomes progressively worse at lower levels. No other significant spinal canal or foraminal stenosis is seen.
1.An enhancing lesion is present within the right sacral ala with probable infiltration of the right S1 neural foramen. This lesion correlates with elevated FDG uptake on PET and could therefore represent a site of active myelomatous disease.2.Nonspecific enhancement centered on the left SI joint may simply be degenerative in nature.3.Marrow signal of the spine is diffusely somewhat heterogeneous but there are no additional focal or enhancing lesions seen. This heterogeneity may reflect prior disease involvement.4.Multiple compression deformities are unchanged with no new compression deformity identified.5.Mildly prominent left upper cervical lymph nodes are nonspecific. Enlargement of the left thyroid lobe is also nonspecific but could be better assessed with dedicated imaging if clinically warranted.