Clinical question: Assess for myelomatous lesions. Signs and symptoms: Nonspecific bone pain. Pre and post enhanced cervical MRI:Cervical vertebral column and partially visualized skull base demonstrate no detectable bone marrow signal abnormality or enhancement to suggest myelomatous lesions as is clinically questioned. There is also no detectable abnormal enhancement of the cord or the leptomeninges.There is normal anatomical alignment of vertebral column. Explain foramen magnum is unremarkable.C2-C3 is unremarkable.C3-C4 demonstrate mild disc disease and mild bilateral ligamentum flavum hypertrophy without spinal stenosis or neural foraminal compromise. There is a tiny right lateral annular fissure best appreciated on sagittal T2 and T2 STIR image 10.C4-C5 demonstrate mild disc disease and loss of disc height, moderate bilateral ligamentum flavum hypertrophy and mild facet disease. Degenerative changes at this level results in mild central spinal stenosis without neural foraminal compromise.C5-C6 demonstrate moderate disc disease and loss of disc height, mild bilateral facet and ligamentum flavum hypertrophy. Constellation of changes results in mild central spinal stenosis and significant bilateral neural foraminal compromise.C6-C7 demonstrate moderate to advanced disc disease and loss of disc height, mild bilateral facet and ligamentum flavum hypertrophy and a disc-osteophyte complex in the midline and extending to the right which results in flattening and posterior displacement of the cord on the right, moderate central spinal stenosis, moderate right and mild left neural foraminal compromise. Subtle T2 increased signal intensity of the cord on the right is suspected.C7-T1 demonstrates mild degenerative changes and unremarkable otherwise.Pre and post enhanced MRI of thoracic spine:Near anatomical morphology, signal intensity and alignment of vertebral column is within normal and without abnormal enhancement.Mild to moderate degenerative disc disease in the mid to lower thoracic spine is noted. There is however no evidence of central spinal stenosis or neural foraminal compromise at any level. The signal intensity and caliber of the cord remains within normal and without detectable abnormal enhancement.At T1-T2 level there is a small non-mass producing left paramedian disc extrusion with slight upward migration posterior to the body of T1. No spinal stenosis or neural foraminal compromise.Pre and post enhanced lumbar MRI:There is no signal abnormality or abnormal enhancement of the vertebral column to suggest myelomatous disease.Normal signal intensity and caliber of the lower most visualized thoracic cord, conus and cauda equina without abnormal enhancement.T12-L1 is unremarkable.L1-L2 is unremarkable.L2-L3 is unremarkable.L3-L4 demonstrate moderate disc disease and loss of disc height, moderate bilateral ligamentum flavum hypertrophy, mild bilateral facet disease however with intravenous left facet effusion. There is a broad base left lateral and far lateral disc protrusion at this level. Constellation of changes results in significant left lateral recess and left neural foraminal compromise and moderate right neural foraminal compromise without central spinal stenosis.L4-L5 demonstrate moderate disc disease and loss of disc height, moderate bilateral ligamentum flavum hypertrophy and moderate right facet hypertrophy and right facet effusion. There is no spinal stenosis however moderate to severe right neural foraminal compromise is detected.L5-S1 demonstrate mild disc disease, moderate bilateral ligamentum flavum hypertrophy, moderate right and mild left facet hypertrophy. No spinal stenosis however moderate to severe right and mild left neural foraminal compromise.
1.Pre- and post enhanced are of of cervical spine demonstrate no evidence of myelomatous lesions. Degenerative changes at C4-C5, C5-C6 and C6-C7 levels with resultant central spinal stenosis (worse at C6-C7) as detailed above. Multilevel neural foraminal compromise is also noted. Questionable T2 hyperintensity of the cord on the right at C6-C7 as detailed above.2.Pre and post enhancement MRI of thoracic spine demonstrate no evidence of myelomatous lesions. Mild degenerative changes and a tiny extruded disc at T1-T2 level as detailed above. No evidence of spinal canal or neural foraminal compromise at any level. No abnormal enhancement of the vertebral column, cord or the leptomeninges.3.Pre and post enhanced MRI of lumbar spine demonstrate no evidence of myelomatous disease. Degenerative changes at L3-L4, L4-L5 and L5-S1 levels and including facet effusion and disc protrusion as detailed. There is no evidence of central spinal stenosis however neural foraminal and lateral recess compromise (some significantly) are present as detailed per level above.