Headaches, history of multiple myeloma. Brain: Compared to prior brain MRI from 11/23/2013, there is been marked interval decrease in size of previously seen extra-axial lesion along the medial/posterior middle cranial fossa. There is small focus of residual enhancement along the posterior aspect of the left Meckel's cave measuring 9 x 17 x 12 mm. There is no abnormal parenchymal or meningeal enhancement on the current study. No new intracranial mass or mass-effect. No hydrocephalus or extra-axial collections. No evidence of acute ischemia or hemorrhage.Compared to 11/23/2013, there is been marked interval increase in areas of abnormal T1 signal, enhancement, and diffusion restriction throughout the calvarium. Marrow signal abnormality involves the skull base including the clivus and occipital condyles.Cervical spine:Vertebral body heights in the cervical spine are normal. Alignment is normal. There is diffuse slightly heterogeneous low T1 marrow signal throughout the cervical spine which is markedly progressed since 6/18/2014. There are new more focal small enhancing lesions, relatively more prominent at C7, T1, and T2 levels, compared to prior post gadolinium study from 3/20/2014. No evidence of compression fracture or epidural tumor. Cervical cord is normal in signal and contour.Osseous and soft tissue lesion at the right C1 to C3 level is markedly decreased when compared to remote MRI studies from 2013. No new soft tissue masses are seen within the cervical spine. There are mild multilevel degenerative changes including small disk osteophyte complex at C5-C6 and uncovertebral hypertrophy with minimal right neural foramina narrowing. There is no significant spinal canal or neural foramina stenosis otherwise in the cervical spine.
1. Compared to brain MRI from 11/23/2013, there is been marked interval decrease in size of previously seen extra-axial lesion along the left medial posterior middle cranial fossa with small residual focus of extra axial enhancement measuring 9 x 17 x 12 mm posterior to the left Meckel's cave. No new intracranial mass or mass effect.2. Compared to prior brain MRI, there is been marked interval increase in diffuse heterogeneous marrow signal abnormality. There is also marked progression of diffuse heterogeneous marrow signal abnormality in the cervical spine. There are new more focal small enhancing lesions, relatively more prominent at C7, T1, and T2 levels, compared to 3/20/2014. While the more diffuse changes may be related to treatment related marrow reconversion, overall findings are suspicious for disease progression and compatible with findings of progression seen on most recent PET from 9/12/2014.3. MRI of the cervical spine demonstrates no large lesions, compression fractures, or epidural tumor. There is no significant spinal canal or neural foramina stenosis. 