Female, 74 years old, with AML and CLL, recently receiving intrathecal and systemic chemotherapy. Reevaluate L5-S3 lesion seen on prior MRI. Bilateral lower extremity weakness and pain. A dextroscoliotic curvature of the lumbar spine is seen along with slight right lateral subluxation of the L4 vertebral body. Vertebral body heights are preserved. Diffuse T1/T2 hypointense marrow replacement is seen. Superimposed on this is patchy STIR hyperintensity and small nodules of enhancement within the L4 vertebral body and spinous process. The L3 inferior endplate is also potentially involved. These findings are not clearly appreciated on the prior examination. However, T2 hyperintense signal within the L3-4 and L4-5 disc spaces was present on the prior exam.Also noted is geographic rim enhancement involving the sacral ala and visualized iliac bones.The previously seen ventral epidural thickening involving L5 and the sacrum is no longer appreciated. No significant compromise of the spinal canal is seen. The distal spinal cord, conus and nerve roots of the cauda equina are unremarkable. No pathologic intrathecal enhancement is observed.Degenerative changes are again seen including disc bulging and facet hypertrophy most notably affecting L3-4 and L4-5. No high-grade spinal canal stenosis is observed. The L5-S1 neural foramina are narrowed.
1.Interval resolution of the previously demonstrated ventral epidural thickening from L5 through the sacrum. This may simply have represented an engorged venous plexus.2.New signal abnormality and foci of enhancement are demonstrated predominantly within the L4 vertebral body and spinous process. While there is disc and facet degeneration at L3-4 and L4-5 which could account for some of these findings, the possibility of leukemic involvement is also raised.3.Geographic rim-enhancing lesions within the sacral ala and visualized iliac bones are compatible with bone infarcts.