Clinical question: Kappa light chain multiple myeloma with increasing back pain. Signs and symptoms: As above. Unenhanced cervical MRI:There is normal anatomical alignment of vertebral column. There is however significant exaggeration of cervical lordosis centered at C5 level.There is large focus of marrow signal T2/T2 hyperintensity of the vertebral body of C5 consistent with clinical diagnosis of multiple myeloma. A punctate focus of similar signal change within the anterior body of C3 is also noted. Mild similar T2/T2 stir hyperintense signal along the superior half of C6 is also present and as well suspected of multiple myeloma. No evidence of fracture. Degenerative changes in particular ligamentum flavum hypertrophy at C4 -- C5 and C5 -- C6 levels results in mild central spinal stenosis. The signal intensity and caliber of the cervical cord is within normal.Nonenhanced thoracic MRI:The alignment of the vertebral column remains anatomical, there is however significant kyphotic deformity of thoracic spine centered at the approximate T7 level and likely secondary to multiple compression deformities of thoracic vertebral bodies.There is subtle concave deformity of the superior and inferior endplates of T2, superior endplates of T3 suggestive of mild compression deformities without associated marrow signal changes.There is more than 50% wedge compression deformity of T5 measuring 16.2-mm posteriorly and 7.7-mm anteriorly. No detectable marrow signal changes.There is uniform increased T2/T2 stir signal intensity of T6 vertebral body with more than 50% compression fracture deformity. The posterior aspect of body of measures at 13-mm in height and anteriorly at 6 mm. Although this exam is nonenhanced there is suggestion of exostosis epidural spread of tumor in the right paramedian anteriorly and extending to the right neural foramina at T6 -- T7 level. This finding is best appreciated on axial T2 series 1701 on image number 8 and sagittal T2/T2 stir series 1301 on image 9. There is mild central spinal stenosis as result of this finding. The sacral intensity of the cord remains within normal.There is less than 50% compression deformity of the superior endplate of T7 without malalignment. There is a large focus of T2/T2 stir hyperintensity in the dorsal aspect of body of T7 on the right.T8 demonstrate diffuse marrow signal abnormality of vertebral body and mild compression deformity consistent metastatic multiple myeloma. There is extra osseous spread of tumor into the spinal canal on the right at T8 level which results in flattening deformity of the ventral aspect of the cord on the right and result in mild central spinal stenosis. This finding is best appreciated on axial T2 series 1401 image 21. Tiny central ventral epidural defect at T8 -- T9 disk level could represent a tiny additional focus of tumor extension and less likely representing a disk herniation/protrusion.At T9 there is a distal marrow signal change consistent with multiple myeloma. There is wedge compression deformity of approximately 50% without malalignment. The dorsal aspect of vertebral body of T9 measures at 20-mm and anteriorly at 10.5-mm.mild compression fracture of superior and inferior endplates of T10 with associated marrow signal changes is also noted.There is also patchy foci of matter signal changes of T1 hypointensity in the vertebral bodies of T11, T12 without T2/T2 stir hyperintensity. There is mild compression fracture of superior endplate of L1 without malalignment and the David is a focus of T2 hyperintensity along the dorsal left aspect of body of T1 suggestive of tumor.Nonenhanced lumbar MRI:Examination demonstrate diffuse patchy foci of marrow signal changes consistent with multiple myeloma throughout the lumbosacral spine involving vertebral bodies and the posterior elements. There is marrow signal changes and less than 50% compression deformity of L4 vertebrae however with maintained normal alignment. Mild compression deformity of L3 is also noted. There is no evidence of central spinal stenosis at any level. Mild to moderate bilateral neural foraminal compromise at lower lumber spine is however present.
1.Nonenhanced MRI cervical spine demonstrate matter signal changes consistent with multiple myeloma extensively involving the vertebral body of C5, superior aspect of vertebral body of C6 and punctate focus in the vertebral body of C3. No evidence of fracture. Mild central spinal stenosis at C4 -- C5 and C5 -- C6 levels secondary to degenerative changes.2.Nonenhanced MRI of the thoracic spine demonstrate multi-level compression fractures of varying degrees involving primarily T5, T6, T7, T9 and T10 levels. There is resultant significant kyphotic deformity of thoracic spine centered at T6 and T7 levels. There is evidence of right lateral ventral epidural and right neural foraminal extraosseous spread of tumor at T6 with result in mild central spinal stenosis. Small right lateral epidural spread of tumor T8 results in mild flattening deformity the cord however without central spinal stenosis. The signal intensity of the cord remains within normal throughout its length. 3.Nonenhanced MRI of the lumbosacral spine demonstrate diffuse osseous marrow signal changes consistent with multiple myeloma. Mild compression fractures of the L3 and to a lesser degree L2 levels are noted. No evidence of malalignment or central spinal stenosis. Neural foraminal compromise in the lower lumber spine secondary to degenerative disease.