Clinical question: Any fracture? Signs and symptoms: Worsening back pain. Nonenhanced thoracic MRI:The alignment of the vertebral column is anatomical.Examination demonstrates an approximately 8mm focus of T2/T2 stir hyperintensity beneath posterior left paramedian T6 vertebrae. Punctate size similar foci of hyperintensity is also noted in the right inferior articulating facet of T11 and T12 and a questionable in the right inferior articulating facet of T9 and 3 body of T8. A larger similar T2 hyperintensity focus is also noted in the proximal right T3 rib measuring at 13 mm size. Findings are highly suggestive of multiple myeloma.There is less than 50% compression deformity of T9 vertebrae without associated T2, T2 stir hyperintensity bone marrow signal changes and suggestive of a chronic fracture. There is however a small patchy foci of T2 hyperintensity within the compressed vertebrae suggestive of multiple myeloma. There is no evidence of malalignment. Very mild chronic compression deformity of the superior endplates of T8 and inferior endplate of T6 are also noted. There is mild exaggeration of thoracic kyphosis which is believed to be at least partially secondary to the above findings.The signal intensity and caliber of cord remains within normal. There is no evidence of neural foraminal or spinal canal compromise or stenosis at any level.Enhanced lumbar MRI:There is normal anatomic alignment of the vertebral column and without evidence of fracture. No evidence of spinal or neural foraminal compromise or stenosis at any level. Mild degenerative disease is noted.There are several small foci of T2/T2 stir hyperintensity involving vertebral bodies and posterior elements of vertebral column, multiple lesions in the sacrum and left iliac wing consistent with multiple myeloma. The largest lesion is along the inferior body of L2 and measuring at 8 x 22.5-mm on sagittal T2 stir. The largest lesion in the visualized sacrum is left and measures at 9 x 8-mm. A left posterior iliac wing lesion measures approximately 6 mm in transaxial dimension.
1.Nonenhanced MRI of thoracic spine demonstrate multiple small foci of T2/T2 stir hyperintensity in the vertebral bodies and the posterior elements and right T3 rib suggestive of multiple myeloma. There is less than 50% chronic compression fracture of T9 with associated patchy marrow signal changes representing multiple myeloma. Mildly exaggerated kyphosis of the thoracic spine. No spinal stenosis or neural foraminal compromise. Normal signal intensity and caliber of thoracic cord.2.Nonenhanced MRI of the lumbar spine demonstrate findings of multiple myeloma involving vertebral bodies and the posterior elements of vertebral column as well as sacrum and iliac wings as detailed/measured above. No fracture or malalignment. No spinal stenosis or neural foraminal compromise.