67-year-old male with plasma cell dyscrasia. Evaluate for lytic lesions of multiple myeloma. Cervical spine:The cervical vertebrae demonstrate diffusely low marrow signal without evidence of edema or pathologic enhancement. The vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology.At C2-3 there is a mild diffuse disk bulge, left greater than right, and moderate facet hypertrophy resulting in minimal central canal stenosis and mild left neuroforaminal stenosis.At C3-4 there is a mild diffuse disk bulge and moderate facet hypertrophy, resulting in mild central canal stenosis and mild left neuroforaminal stenosis.At C4-5 there is moderate facet hypertrophy with no significant central canal stenosis and mild right neuroforaminal stenosis.At C5-6 there is moderate diffuse disk bulge and facet hypertrophy resulting in moderate central canal stenosis and no significant neuroforaminal compromise.At C6-7 there is moderate facet hypertrophy without significant central canal stenosis or neuroforaminal compromise.At C7-T1 there is no significant compromise to spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.MRI thoracic spine:As above, the thoracic vertebrae demonstrate diffusely low marrow signal. The vertebral bodies are appropriate in the overall alignment and height. Few fat containing lesions may represent hemangiomas. The thoracic spinal cord has normal signal characteristics and overall morphology. Mild multilevel degenerative changes are present with scattered disk protrusions; most conspicuously a left paracentral T11-T12 protrusion and disk bulge results in mild central canal stenosis. Bilateral cystic renal lesions are partially imaged though on the right appear mildly complex and larger as compared to previous CT abdomen from 2007.Lumbar spine:The lumbar vertebrae also demonstrate diffusely low marrow signal. Five lumbar type vertebral bodies are present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L1-2 there is mild diffuse disk bulge, ligamentum flavum hypertrophy and facet hypertrophy, resulting in mild central canal stenosis and mild bilateral neuroforaminal narrowing.At L2-3 there is disk disease with loss of disk height, diffuse disk bulge and facet hypertrophy, resulting in mild central canal stenosis as well as moderate bilateral neuroforaminal compromise.At L3-4 there is diffuse disk bulge, facet hypertrophy, and mild ligamentum flavum hypertrophy resulting in mild central canal stenosis and no significant neuroforaminal compromise.At L4-5 there is a grade 1 anterolisthesis of L4 on L5, degenerative disk disease with loss of disk height, severe facet hypertrophy, and mild ligamentum flavum thickening, resulting in mild central canal stenosis and moderate to severe bilateral neuroforaminal stenosis.At L5-S1 degenerative disk disease with loss of disk height and facet hypertrophy, without significant neuroforaminal or central canal compromise.
1.Diffuse low marrow signal throughout the spine is suggestive of red marrow reconversion, which may be seen in patients with anemia or on marrow stimulation therapy.2.No specific evidence of myelomatous lesions.3.Degenerative changes, as above.4.Right renal cystic lesions are partially imaged and incompletely evaluated, though appear larger than seen previously and are mildly complex. Dedicated renal imaging is recommended.