73-year-old male with urinary retention. Evaluate for cord compression. Brain MRI:There are diffuse osseous myelomatous bony changes throughout the calvarium without cortical breakthrough. Dural thickening along the clivus is likely reactive to marrow diseae. There is no abnormal intraparenchymal enhancement or mass-like lesion. There is nonspecific scattered FLAIR signal abnormality involving the periventricular and subcortical white matter which is likely related to small vessel ischemic changes.There is no evidence of intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Lumbar Spine MRI:Again visible within the lumbar spine is diffuse T1 dark signal indicating marrow replacement most likely from a history of myelomatous disease. There are multilevel degenerative changes and grade 1 anterolisthesis of L4 on L5. The remainder of the lumbar spine shows lordotic curvature. There is approximately 25-50% vertebral body height loss involving the L2 vertebral vertebral body. There is no evidence of retropulsion of the fracture fragments. There is variable disc height loss involving the lumbar spine, most prominent at the L2-3, L4-5 and L5-S1 levels. Within the spinal canal is abnormal enhancing soft tissue invading the epidural space, dorsally more than ventrally. This abnormality begins at the L1 vertebral body level and continues down to the L5 level. This tissue results in significant spinal canal stenosis and crowding of the cauda equina from L2 through L4. There is at least moderate to severe spinal canal stenosis extending more superiorly from the L4-5 level to the posterior aspect of the L2 vertebral body. There is also prominent enhancement and edema of the adjacent paraspinal muscles and psoas muscles.
1.Severe spinal canal narrowing in the lumbar region due to circumferential epidural tumor with some contribution from adjacent degenerative change. 2.Prominent enhancement and edema of the lumbar paraspinal muscles and psoas muscles is most likely to represent an inflammatory process perhaps reactive to radiotherapy, less likely paraspinal myelomatous involvement.3.Diffuse osseous myelomatous bony changes involving the calvarium without cortical breakthrough an no abnormal intraparenchymal enhancement or tumor-like lesions. 4.Scattered likely chronic small vessel ischemic changes.