Female, 61 years old, with history of multiple myeloma and back pain, with history of T12, L1 and L2 fractures. Assess for healing and for evidence of any new fractures. Thoracic:Spinal marrow signal density remains heterogeneous but is less uniformly T1 hypointense when compared to the prior examination which may reflect a return to relatively more fatty marrow consistency. A well marginated T1/T2 hyperintense lesion within the posterior T10 vertebral body is unchanged. Since the prior examination, evidence of kyphoplasty is seen at the T12 level. The T12 vertebral body remains significantly compressed, similar in degree to the prior examination. There appears to be mild extrusion of cement into the left paracentral epidural space at T12 which causes effacement of the ventral thecal sac but no significant generalized spinal canal stenosis. No new vertebral body compressions are seen. Spinal alignment is relatively anatomic. No significant vertebral body edema is seen. The proximal right T10 rib is STIR hyperintense, slightly more so than on the prior examination.The visualized spinal cord demonstrates normal signal intensity and morphology throughout. No significant compromise of the spinal canal or neural foramina are noted.A septated left renal cyst is unchanged.Lumbar:Comparison the thoracic spine, bone marrow signal characteristics remain heterogeneous but less uniformly T1 hypointense perhaps representing return to a relatively more fatty marrow consistent.Concavity of the posterior inferior endplate of the L1 vertebral body is again seen appearing similar to the prior examination and resulting in mild loss of vertebral body height. Significant compression of the L2 vertebral body with near complete loss of height centrally is again seen, also similar to prior. Mild retropulsion of vertebral body material is seen at both levels without significant interval change. The spinal canal is not significantly narrowed.No new compression deformity is seen. No evidence of vertebral body edema is noted.The distal spinal cord, conus and cauda equina show normal morphology. No significant compromise of the spinal canal is seen. The neural foramina are mildly narrowed at L1-2 and L2-3 bilaterally due to the vertebral body compressions. Mild disc bulging is seen at L3-4.There is a kyphotic angulation of the upper lumbar spine due to compression deformities. Spinal alignment is otherwise unremarkable.
1.Interval kyphoplasty of the compressed T12 vertebral body. No new compression deformities are seen in the thoracic spine.2.No significant change in compression fractures of the L1 and L2 vertebral bodies including mild retropulsion of osseous material. No new lumbar compression deformity is are seen.3.No significant compromise of the spinal canal is noted at any level in the thoracic or lumbar spine.4.The spinal marrow in general shows heterogeneous signal but with a less uniformly T1 hypointense appearance. This could represent a reduction in myelomatous infiltration, or reduction in marrow activation, with return of a relatively more fatty marrow consistency.