History of multiple myeloma presenting with left gaze deviation. Patient also has bilateral lower extremity weakness and probable lumbar plasmacytoma noted on prior limited cord compression MRI. Brain:There is a soft tissue mass centered within the clivus that is isointense to gray matter on T1 and T2 sequences which measures 2.1 x 3.0 x 1.9 cm (transverse by AP by cc). There is avid homogenous enhancement on the postcontrast images. Given the patient's history of multiple myeloma and the predominantly intraosseous location this most likely represents a myelomatous lesion. This extends intracranially into the left prepontine cistern and extends into the inferior left cavernous sinus as well as abutting the left Meckel's cave. There appears to be at least partial encasement of the left internal carotid artery, without significant associated stenosis. Lobular enhancing soft tissue also extends into the left sphenoid sinus. The wall of the sinus appears eroded, however this would be better with evaluated CT. There is no evidence of intracranial hemorrhage edema. The ventricles and basal cisterns are normal in size and configuration. Aside from the left sphenoid sinus, the paranasal sinuses are clear. The visualized mastoid air cells are clear. The orbits are unremarkable. The calvarium is diffusely decreased T1 marrow signal compatible with the history of myeloma.Lumbar spine:Redemonstration of an pathologic compression fracture involving the T12 vertebral body resulting in approximately 40% loss of vertebral body height. There is no significant associated retropulsion of the fracture fragments. The remaining vertebral body heights are preserved. Alignment is within normal limits.There is diffusely abnormal bone marrow signal and patchy intraosseous enhancement throughout the visualized osseous structures compatible with the history of myeloma. There is enhancing epidural soft tissue posterior to the L4 vertebral body. Minimal enhancement dorsal to the L5 vertebral body may represent minimal epidural tumor versus venous plexus. Epidural tumor at the L4 level measures 8 mm in maximum thickness with encroachment of the lateral recesses. Neural foramina more laterally are patent. Additional poorly defined enhancing soft tissue anterior to the L3 and L4 vertebral bodies measuring up to 2.6 x 1.3 cm is compatible with additional extraosseous tumor extension. No convincing evidence of leptomeningeal tumor involvement.There is additional extensive tumor involvement involving the right sacral body and bilateral iliac bones which is partially imaged.Partially visualized markedly distended bladder.Additional level by level findings are as follows:T12-L1: No disc bulge, spinal canal stenosis, or neuroforaminal narrowing.L1-L2: Mild diffuse disc bulge. No spinal canal stenosis or neuroforaminal narrowing.L2-L3: Moderate disc bulge. Minimal spinal canal and bilateral neural foraminal narrowing.L3-L4: No disc bulge, spinal canal stenosis, or neuroforaminal narrowing.L4-L5: Ventral epidural tumor as described above resulting in minimal central canal stenosis and significant encroachment on the lateral recesses, left greater than right. No significant neural foraminal stenosis.L5-S1: Minimal ventral epidural tumor extension is questioned dorsal to L5 vertebral body. There is a mild disc bulge. No significant neural foraminal or spinal canal stenosis.
1. Enhancing soft tissue mass centered within the clivus with intracranial extra-axial extension into the left prepontine cistern and left cavernous sinus. Findings consistent with a myeloma lesion.2. Multifocal multiple myeloma tumor involvement in the lumbar spine with extension of tumor into the ventral epidural space at the L4 level. There is encroachment of the lateral recesses and mild central canal narrowing. Enhancement dorsal to the L5 vertebral body is more nonspecific but may represent minimal epidural tumor.3. There is additional extensive tumor involvement involving the right sacral body and bilateral iliac bones which is partially imaged.4. Distended bladder. Correlate for signs and symptoms of neurogenic bladder/urinary retention.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.