Male, 61 years old, with pancytopenia and severe back pain. Assess for metastatic disease. Please note that image quality is compromised by low signal-to-noise ratio and perhaps some degree of motion artifact. Within this limitation, the following observations are made.In the cervical region, vertebral bodies demonstrate diffusely low T1 signal suggestive of marrow replacement. Scattered areas of T2 hyperintensity and enhancement are also evident within the C2, C5 and T1 vertebral bodies. These are confined to the marrow space and, within the limitations of exam quality, no evidence of any paraspinal or epidural component is seen.In the thoracic lumbar region, again diffuse marrow replacement on T1-weighted images is seen. There is, however, a more extensive diffuse pattern of pathologic marrow enhancement involving the majority of the marrow space with some geographic regions of hypoenhancement. Again, within the limitations of image quality, no significant paraspinal or epidural disease component is seen.The visualized spinal cord, conus and cauda equina demonstrate normal intensity pathology. No convincing evidence of leptomeningeal enhancement is seen. No intraspinal masses are detected.Spinal alignment is anatomic. Vertebral body heights are preserved.In the cervical region, mild disc osteophyte formation, uncovertebral hypertrophy and facet hypertrophy result in foraminal narrowing at C4-5, C5-6, and C6-7. No high-grade spinal canal stenosis is detected.In the thoracic region, no significant degenerative disc disease, spinal canal stenosis or foraminal narrowing is seen.In the lumbar region, the following level specific findings are noted:L1-2: Unremarkable. L2-3: Mild facet hypertrophy. Minimal bulging disc. No significant spinal canal or neuroforaminal stenosis. L3-4: Mild facet hypertrophy. Mild bulging disc. No significant spinal canal stenosis. Mild bilateral foraminal narrowing. L4-5: Facet hypertrophy. Bulging disc. Mild generalized spinal canal stenosis. Mild to moderate bilateral foraminal narrowing. L5-S1: Mild facet hypertrophy. No significant spinal canal or neuroforaminal stenosis.
Diffuse marrow replacement and pathologic marrow enhancement is seen, particularly involving the thoracic and lumbar spine. The possibility of an infiltrative hematologic process or hematologic malignancy is favored.No evidence of any vertebral body compression deformity is seen. Within the limitations of a somewhat degraded examination, no significant epidural soft tissue process is detected.Mild degenerative findings are evident as noted above, but no areas of high-grade spinal canal or neuroforaminal stenosis are suspected.