Clinical question: History of a smoldering multiple myeloma. Evaluate for myelomatous lesions. Signs and symptoms: Most recent bone marrow with 30% plasma cells; 2 Right iliac lucencies seen on CT. Pre and post enhanced cervical MRI:Examination demonstrates a focus of T2 STIR hyperintensity measuring at 7 x 8 mm (sagittal T2 STIR series 501 image 12) with enhancement in the right lateral mass of C1 which considering patient's history of multiple myeloma possibility of a myelomatous infiltrate should be considered. The signal intensity and the anatomical alignment of vertebral column is otherwise unremarkable and without detectable abnormal enhancement.Foramen magnum is unremarkable.C2-C3 is unremarkable.C3-C4 demonstrate mild degenerative changes with resultant moderate left neural foraminal compromise and no central spinal stenosis.C4-C5 demonstrate moderate disc disease, loss of disc height, moderate right and mild left facet and ligamentum flavum hypertrophy. There is resultant significant right neural foraminal compromise and mild to moderate on the left and no central spinal stenosis.C5-C6 demonstrate disc disease and moderate bilateral ligamentum flavum hypertrophy with mild facet disease. There is a small right paramedian disc/osteophyte complex which is in contact and mildly flattens the ventral aspect of the cord on the right without central spinal stenosis or neural foraminal compromise.C6-C7 demonstrate mild disc disease, mild bilateral facet and moderate bilateral ligamentum flavum hypertrophy. No central spinal stenosis however mild bilateral neural foraminal compromise is present.C7-T1 is unremarkable.Pre and post enhanced thoracic MRI:There is normal anatomical alignment of vertebral column.Examination demonstrates no detectable foci of abnormal signal intensity or enhancement to suggest presence of myelomatous infiltrate.Degenerative disc disease at T11-T12 and including the tiny enhancing Schmorl's node along the inferior endplate of T11 is noted.There is normal signal intensity and caliber of the thoracic cord without abnormal enhancement.There is no evidence of spinal stenosis at any level. There is no clinically significant neural foraminal compromise at any level.There is no detectable. Spinal soft tissue abnormalities.Pre- and post enhanced lumbar MRI:Examination demonstrates no detectable foci of abnormal signal intensity or enhancement of the vertebral column to suggest metastatic myelomatous disease.There is normal anatomical alignment of vertebral column.There is mild to moderate disc disease and hypertrophic changes of posterior elements however without evidence of central spinal stenosis at any level. There is also no evidence of clinically significant neural foraminal compromise.Unremarkable perispinal soft tissues.Normal signal intensity, caliber and morphology of conus and the cauda equina without detectable abnormal enhancement.
1.MRI of cervical spine demonstrate a single 7 x 8 mm focus of T2Stir hyperintensity with enhancement in the right lateral mass of C1 as detailed. This finding is nonspecific however considering patient's history of multiple myeloma possibility of metastatic lesion should be considered and follow-up is recommended. Degenerative changes of cervical spine with resultant mild central spinal stenosis without evidence of central spinal stenosis. There is however multilevel neural foraminal compromise (some significantly) as detailed per level above. Normal signal intensity of the cord and without abnormal enhancement.2.MRI of thoracic spine demonstrate no detectable metastatic multiple myeloma. Normal signal intensity and caliber of the cord without abnormal enhancement. No spinal stenosis or neural foraminal compromise at any level. Degenerative changes and including a tiny Schmorl's node along the inferior endplate of T11 as detailed above.3.MRI of the lumbosacral spine demonstrate no detectable metastatic disease. Mild degenerative changes of lumbar spine without spinal stenosis or neural foraminal compromise. No detectable abnormal signal or enhancement of the conus or the cauda equina.