Male, 65 years old, with IgG kappa oligosecretory multiple myeloma and new back pain. Diffuse osseous marrow replacement is seen affecting every vertebral body level compatible with myelomatous involvement. The marrow signal characteristics of a majority of the involved levels demonstrate T1 hypointensity and mild fairly uniform STIR hyperintensity.At T1, there is a severe compression deformity with slight retropulsion and effacement of the ventral thecal sac. No high-grade canal stenosis or cord compression is seen.Moderate compression deformities and or loss of vertebral body height is seen throughout the lumbar spine beginning at T4 and continuing down to T11. No significant retropulsion is seen in the thoracic region. None of these compression deformities is associated with particular STIR hyperintensity.A mild anterior compression of the L1 vertebral body is seen without retropulsion. Within the L2 vertebral body, a conspicuously STIR hyperintense lesion is evident anteriorly which may represent a relatively more active or edematous lesion.Within the sacrum, expansile tumor is demonstrated involving the posterior elements of S2 and the anterior aspects of the more distal sacral levels, partially visualized. Elsewhere, no expansile lesions or extraosseous spread is suspected. Within the limitations of a noncontrast examination, no epidural involvement is suspected.Spinal alignment of the cervical region is grossly intact. Exaggeration of the thoracic kyphosis is demonstrated. Spinal alignment in the lumbar region is grossly intact.Multilevel facet arthropathy and disc osteophyte formation is seen in the cervical spine. This affects C5-6 most severely with mild effacement of the ventral thecal sac. Scattered moderate to severe foraminal narrowing is also demonstrated. Mild degenerative findings are seen at most levels in the thoracic spine. There is a prominent right paracentral disc protrusion at T10-11. No high-grade spinal canal or foraminal stenosis is suspected.Facet arthropathy develops at lower lumbar levels. Mild disc bulging is seen at L1-2, L2-3 and L3-4. No significant spinal canal or foraminal stenosis is seen.
1.Diffuse myelomatous involvement is seen involving the entire spine including vertebral bodies and posterior elements. At most levels, no evidence of extraosseous tumor is seen. However, expansile tumor is demonstrated in the sacrum.2.Multiple compression deformities are redemonstrated including a severe compression of T1 and moderate compressions of most of the mid to distal thoracic vertebrae. These levels show no particular edema suggesting that they are relatively chronic in time course.3.Within the limitations of a noncontrast examination, no evidence of any epidural tumor involvement or cord compression is seen.4.Multilevel degenerative findings are demonstrated as discussed above but without any high-grade spinal canal stenosis.