Multiple myeloma.. The marrow is diffusely heterogeneous in signal which can be reflective of involvement by multiple myeloma and/or reactive red marrow. There is no pathologic compression fracture. Mild posterior height loss at L5 is probably degenerative in nature given the associated endplate/matter typeII. Degenerative signal.There is a posterior epidural T2-hyperintense, mildly T1-hyperintense (relative to muscle) which anterior displaces and mildly compresses the spinal cord. This extends from C6-C7 level to the mid T5 level (craniocaudal length of 12.5 cm) and has a maximum anteroposterior diameter of 1.0 cm. The compressed spinal cord signal shows a subtle increase in STIR signal but this can also be artifactual. There is no significant compression of the thecal sac otherwise. While this may represent epidural hemorrhage, it is more likely to represent epidural involvement by multiple myeloma especially given the below-described paraspinal mass, which has similar signal characteristics. Partially imaged is a left sided paraspinal mass at T3 level with superior extension to T2 level with extension towards the left T2-T3 and T3-T4 neural foramina. This is probably related to extraosseous involvement by multiple myeloma. These were not present on the previous examination from December 2014.
1.Cervicothoracic (C6-C7 through mid T5) posterior epidural soft tissue with compression of the thecal sac/spinal cord is most probably related to involvement by the known multiple myeloma. There is suggestion of subtle increase in cord STIR-signal. However, the study was limited to T1 and STIR sequences in the sagittal plane and therefore cannot accurately assess for cord edema.2.Thoracic left paraspinal soft tissue mass has similar signal characteristics and is also most compatible with extraosseous involvement by multiple myeloma.Contrast-enhanced thoracic spine MRI would more definitively assess the above described epidural component and the mass effect it causes on the spinal cord.Dr. Monther Qandeel discussed the above findings and recommendations with Dr. Anubha Ganjoo over the phone on Oct 31, 2015 at 1044 hours. 