Multiple myeloma, paraplegia, possible bowel incontinence. Suspected acute cord compression. Please note patient could not tolerate the complete study. Thoracic imaging is limited to sagittal sequences and no post gadolinium imaging was performed.Cervical spine:Lack of contrast slightly limits evaluation. There are small foci of low T1 signal scattered throughout the cervical spine consistent with metastatic disease. Relatively larger focus involving the C2 vertebra measures approximately 13 mm in diameter. No prior cervical MRI is available for comparison, aside from cord compression study from 11/18/2015. Vertebral body heights in the cervical spine are normal. Alignment is grossly maintained. Multilevel degenerative changes are seen including a right paracentral disc protrusion at the C3-C4 level which indents the ventral cord. There is overall moderate spinal canal stenosis at this level without cord signal abnormality. Degenerative changes also include uncovertebral hypertrophy at the C5-C6 level where there is moderate right and mild left neural foraminal stenosis. Aside from the aforementioned C3-C4 level, there is no significant spinal canal stenosis in the cervical spine. No obvious epidural mass is evident within the limitations of noncontrast study.Thoracic spine:Evaluation of the thoracic spine limited to noncontrast sagittal sequences. Again seen is diffuse osseous metastatic disease which appears progressed compared to 6/8/2015, with multiple new lesions throughout the thoracic spine. The largest new lesion is seen involving the anterior T6 vertebral body and measures 16 x 14 mm in the AP and craniocaudal dimensions. Relatively larger lesions involving the T3 vertebral body is again seen. There is suggestion of decrease in epidural tumor at this level although suboptimally evaluated without contrast. Extensive tumor infiltration involving the T9 posterior elements with dorsal epidural tumor at the T9 level again seen which is associated with compression of the thoracic cord. Mild increase in craniocaudal extent of epidural tumor. There is edema within the cord from approximately T8-T10 which appears mildly worse compared to 6/8/2015. There also appears to be increased tumor infiltration involving the T9-T10 11 posterior elements and paraspinous soft tissues on the sagittal images.Again seen is a severe compression fracture involving the T8 vertebral body which mild interval worsening of height loss. There appears to be decrease in epidural tumor at this level. No new compression fractures are evident.Lumbar spine:Evaluation of the lumbar spine limited to sagittal STIR sequence again demonstrate multiple small metastatic lesions in the lumbar spine and sacrum without evidence of new large lesions. Compression fracture with moderate loss of height involving the L1 vertebral body similar to prior. Mild associated retropulsion and minimal spinal canal narrowing similar to prior. Otherwise no significant spinal canal stenosis is evident in the lumbar spine. No new pathologic compression fractures.
1. Please note patient could not tolerate the complete study. Thoracic and lumbar imaging is limited to sagittal sequences and no post gadolinium imaging of the spine was obtained.2. Multiple new metastatic lesions are seen throughout the thoracic spine compared to 6/8/2015. Multiple small lesions are present throughout the cervical spine, with no prior cervical spine MRI available for comparison. Multiple small metastatic lesions in the lumbar spine and visualized pelvis are also seen without evidence of a new large lesion.3. There is suggestion of decrease in epidural tumor at the T3 and T8 levels with decrease in associated mass effect on the cord at this level but suboptimally evaluated without contrast and absence of axial images. 4. Mild increase in craniocaudal extent of epidural tumor at the T9 level which appears to be compressing the cord and is associated with worsening of cord signal abnormality at this level.5. Severe pathologic fracture at the T8 level which demonstrates mild worsening of height loss at this level. Compression fracture involving the L1 vertebral body with mild associated osseous retropulsion and minimal spinal canal narrowing are similar to prior. No new pathologic compression fractures are evident. No obvious epidural mass in the cervical or lumbar spine within the limits of noncontrast study.6. Degenerative changes at the C3-C4 level with up to moderate spinal canal stenosis at this level, without cord signal abnormality.