Multiple myeloma not having achieved remission [C90.00], Reason for Study: ^Reason: 64 y/o with multiple myeloma; please evaluate L5 lesion seen on previous MRI History: right hip/low back pain For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. Previously seen L5 body right inferior posterior aspect lesion is again seen. The lesion shows eccentric protrusion toward right L5S1 lateral recess and abuts thecal sac with slightly inhomogeneous enhancement.Though the imaging parameters are different, overall size and MR imaging characteristics of above lesions such as signal intensity do not show any significant interval change since prior scan.The MR signal intensity of whole lumbosacral spine and bilateral iliac bones show replacement of normal fatty marrow signal intensity, unchanged since prior scan.On Gad enhanced scan, multifocal inhomogeneous enhancing lesions are seen all lumbosacral vertebral bodies and bilateral iliac bones, these lesions may indicate focal aggregation of tumor lesions. There is normal lumbar lordosis. The spine alignment is anatomic. The vertebral body height is preserved. The signal of the visualized cord is normal. The conus medullaris terminates at the L1-L2 level. Degenerative changes are specified by the intervertebral level as follows: T12-L1: no neuroforaminal narrowing or spinal stenosis. L1-L2: no neuroforaminal narrowing or spinal stenosis. L2-L3: no neuroforaminal narrowing or spinal stenosis. L3-L4: minimal left paramedian focal disc bulging, unchanged since prior scan. Minimal spinal canal narrowing due to bilateral ligamentum flavum thickening. L4-L5: Broad based central to left disc protrusion, unchanged. The protruded disc results minimal left side lateral recess narrowing, again, unchanged. L5-S1: Right posterior inferior L5 vertebral body lesion which abuts thecal sac especially on the right side and mildly narrows right lateral recess, unchanged since prior scan.
1. Unchanged size and MR characteristics of the L5 vertebral body right posterior inferior lesion since prior scan.2. Diffuse replacement of normal fatty marrow with multifocal enhancing lesions, consistent with multiple myeloma involvement.3. No evidence of compression fracture.4. Unchanged degenerative disc lesions of lumbar spine since prior scan.