 The exam is motion degraded limiting evaluation, which is further limited due to lack of IV contrast due to patient's low GFR. The last well-formed disk space is referred to as L5-S1. The osseous marrow signal is diffusely low on T1 as compared to the disk signal, compatible with patient's history of multiple myeloma. There is normal alignment of the lumbar spine. There is loss of T2 disk signal in multiple levels with loss of disk height at L5-S1, along with type II degenerative endplate changes. There is no evidence of acute fracture with preserved vertebral body heights. The conus terminates at L2 and shows grossly normal signal.There is mild posterior cortical bulge of T11, T12, L4 and L5 with mild expansion of the T11 and T12 pedicles. At these levels, there is effacement of the ventral CSF space due to posterior cortical bulging without significant spinal canal stenosis. These findings are compatible with expansile myelomatous lesions. Level by level details are as follows:T11-12: Effacement of ventral CSF space without significant spinal canal stenosis secondary to posterior cortical bulging at T11. No significant disk herniation. Expansion of the pedicles results in severe right and mild left neural foraminal stenosis.T12-L1: Effacement of ventral and lateral CSF space at T12 level due to epidural tumor without significant compression/deformity of the cord or abnormal T2 signal within the cord. No significant disk herniation or neural foraminal stenosis.L1-2: No significant disk herniation, spinal canal or neural foraminal stenosis.L2-3: Mild disk bulge and bilateral facet arthropathy with ligamenta flava thickening causing mild to moderate right and mild left neural foraminal stenosis with no spinal canal stenosis.L3-4: Mild diffuse disk bulge and bilateral facet arthropathy with ligamenta flava thickening causing mild to moderate right and mild left neural foraminal stenosis.L4-5: Posterior cortical expansion/epidural tumor at L4 abutting the bilateral traversing L5 nerve roots in the subarticular zones without significant displacement. Diffuse disk bulge, bilateral facet arthropathy and ligament flava thickening causing minimal bilateral neural foraminal stenosis and no significant spinal canal stenosis.L5-S1: Posterior cortical expansion/epidural tumor at L5 which is asymmetric to the left encroaching upon and causing stenosis of the left subarticular zone; suspect mild traversing left L5 nerve root compression. Diffuse disk bulge, and mild bilateral facet arthropathy causing mild left neural foraminal stenosis and no significant right neural foraminal stenosis.
1.Motion degraded examination which is further limited due to lack of IV contrast secondary to patient's chronic renal disease and low GFR.2.Diffusely low T1 signal in the osseous marrow compatible with diffuse myelomatous infiltration. No evidence of acute fracture.3.Myelomatous lesions in T11, T12, L4 and L5 vertebral bodies cause posterior cortical expansion/epidural tumor invasion.4.Marked effacement of the CSF space around the cord without significant compression/deformity or T2 signal within the cord. Spinal canal is most compromised at this level, followed by L5 vertebral body level where epidural tumor compresses upon the traversing left L5 nerve root in the left subarticular zone. Please correlate for left L5 radiculopathy.5.Variable degrees of neural foraminal narrowing as described above. In particular, at T11-12, there is tumor expanding the pedicles of T11 and T12 causing severe right and mild left neural foraminal stenosis.