Clinical question: 60-year-old female with history of MM, pathologic fracture. Signs and symptoms: Pain, with old L2 compression fracture, now new T12 and L1 acute fractures. Pre-and post-enhanced thoracic MRI:The examination demonstrates a well-demarcated focus of increased T2 and T2 stir signal intensity in the vertebral body of T12 measuring at 17-mm AP and 9-mm cc in size on sagittal T2 stir series. This finding demonstrate T1 hyperintense signal pattern and the cuneiform enhancement. Finding is suggestive of a metastatic multiple myeloma. The marrow signal intensity of T12 vertebrae is otherwise unremarkable and without abnormal enhancement or bone marrow edema to suggest acute fracture, there is however more than 50% compression deformity of T12 vertebrae on the left which is suggestive of a chronic compression fracture. The maximum height of T12 vertebra measures at 21-mm and 7-mm on the left at the level of maximum compression deformity. The alignment of the vertebral column remains within normal at this level and without compromise of canal. Mild left neural foraminal compromise at T12 -- L1 is detected.There is no evidence of any additional compression deformity of the thoracic vertebral column. The no evidence of spinal stenosis or compromise at any level. No significant neural foraminal compromise is detected.There is uniformly abnormal signal intensity of vertebral column and with multiple small foci of enhancement within the vertebral bodies and posterior elements suggestive of multiple myeloma.Compared to prior examination there is no significant change in the extent of above detailed findings. Slightly less conspicuous patchy marrow signal abnormality of vertebral column on the current exam could be result of treatment or technique related.The signal intensity and caliber of cord remains within normal and without abnormal enhancement.Pre-and post-enhanced lumbosacral spine:This examination demonstrate significant compression fracture of L1 vertebrae with mild bulge of compressed vertebra into the spinal canal however without central spinal stenosis or significant neural foraminal compromise. This appearance remains identical to prior exam from 10 -- 27 -- 2014. The alignment of vertebral column remains anatomical otherwise and without evidence of central spinal stenosis or compression fracture.Diffuse patchy marrow signal changes of the vertebral column consistent the patient's history of multiple myeloma is less conspicuous on current exam compared to prior.The signal intensity of the conus and cauda equina is within normal and without abnormal enhancement.
1.Pre-and post-enhanced MRI of thoracic spine demonstrate a well-demarcated enhancing mass in the vertebral body of T12 consistent with a multiple myeloma. There is more than 50% compression deformity of the left side of T12 vertebrae without associated marrow signal changes or enhancement and suggestive of a chronic fracture. No interval change since prior exam. Multiple additional small foci of marrow signal change and enhancement involving vertebral bodies and the posterior elements of thoracic spine consistent with metastatic disease without appreciable change since prior study. There is no evidence of spinal canal or significant neural foraminal compromise at any level. Normal signal intensity and caliber of the cord without abnormal enhancement. 2.Pre-and post enhanced lumbar MRI demonstrate no areas of any acute or definitive new findings since prior study from 2014. Stable significant chronic compression fracture of L1 with mild expansion into the spinal canal and without spinal stenosis. Diffuse marrow signal changes of vertebral column consistent with patient's known multiple myeloma is a slightly less conspicuous on current exam. No evidence of spinal stenosis or neural foraminal compromise.