49 old female with history of multiple myeloma with cord compression. Rule out cord compression. Diffuse low T1 signal throughout the cervical, thoracic and lumbar vertebral bodies consistent with multiple myeloma involvement of spinal column. There is remaining fat within T7 vertebral body unchanged. There is a new extra-medullary lesion posterior aspect of extradural space at the T4-T5 level measuring 1.1 cm in thickness and 2.8 cm in the craniocaudal dimension (series 401, image 7) which compresses the cord at this level; there is subtle increased STIR signal within the cord at this level however grossly the remaining spinal cord signal is unremarkable. There is an additional new right paraspinal mass lesion at T2 level measuring 19 mm x 13 mm (series 1601, image 21) which demonstrates intermediate T2 and low T1 signal. There is progressing compression fracture deformity of T12 vertebral body which demonstrates diffuse STIR signal; vertebral body height currently measures 16 mm, previously 19 mm. Increased STIR signal in the superior endplate of L2 vertebral body appearing more conspicuous on the current exam with an associated Schmorl's node. There is a new extramedullary lesion posterior to the L4 vertebral body measuring up to 9 mm in thickness (series 801, image 7) demonstrating intermediate T1 and STIR signal intensity. The lesion shows mild mass effect toward the spinal canal and cauda equina nerve roots. There is increased STIR signal within S1 vertebral body as well as a partially imaged known right sacroiliac mass. There is a focal rounded lesion posterior to the L1 vertebral body and anterior to the cord measuring 12 mm x 6 mm (series 701, image 7) which demonstrates low T1 and STIR signal and is new from prior study however of unclear etiology; this demonstrates no significant mass effect on the spinal cord. Multilevel degenerative changes not significant change from prior study including mild indentation of the spinal cord at multiple levels most prominent within the upper cervical spine.
1. Findings most likely represent new extra medullary plasmacytomas at T2 (paraspinal), T4-T5 level (extradural intraspinal) and L4 (retro corporeal extradural) level. 2. There is associated marked compression of the cord with subtle increased STIR signal of the spinal cord at T4-5 level which could represent cord edema however grossly the spinal cord signal is unremarkable throughout its course. 3. Progressing compression fracture at T12 with associated marrow edema.4. The lesion at L4 level demonstrates mild mass effect on the thecal sac and cauda equina nerve roots. 5. Increased STIR signal within S1 vertebral body appearing more conspicuous on the current exam and could represent myelomatous disease; known right sacroiliac mass is partially imaged. 6. New focal rounded lesion posterior to the L1 vertebral body and anterior to the cord of unclear etiology and demonstrates no significant mass effect on the spinal cord; this may be artifactual or could represent an additional tumor deposit. Comment: Dedicated lumbar MRI WWO can be considered for further imaging investigation for above #4, #5, and #6 findings.Findings were discussed with Dr. Linda Zhu by phone on 1/7/2016 at 5:10 PM. 