Multiple myeloma and ependymoma, evaluate interval change Five lumbar type vertebral bodies are presumed to be present. Again seen are multiple compression fractures including the T11, T12, L2, L3, and L4 vertebral bodies, not significantly changed since prior study from 2/19/2015. Relatively worse height loss is at T12 with approximately 70% loss of height. No bone marrow edema associated with the fractures to suggest recent loss of height.There is worsening of marrow signal abnormality including a rounded lesion involving the L3 vertebral body measuring approximately 2 cm in diameter, which is not definitively appreciated previously. There is also increased in diffuse mottled appearance of the bone marrow signal particularly from the L5 level through the pelvis. Multiple enhancing lesions are evident involving the sacrum and iliac bones bilaterally, which are new since 2/19/2015.Postoperative changes of laminectomy are seen at the L4-L5 and L5-S1 levels with small residual fluid collection in the posterior extradural soft tissues again noted.Multilevel degenerative changes are seen, as described below:L1-2: Mild disc bulge and unchanged small superimposed left paracentral disc extrusion with superior migration posterior to the L1 vertebra. No significant spinal canal stenosis. Minimal bilateral foraminal narrowing. L2-3: Mild facet and ligamentum flavum hypertrophy. Mild disc bulge. No significant spinal canal stenosis. Minimal right foraminal narrowing. L3-4: Mild facet and ligament flavum hypertrophy. Mild disc bulge. Unchanged prominent epidural fat contributes to mild narrowing of the spinal canal without significant stenosis. Mild bilateral foraminal narrowing. L4-5: Postsurgical change. Moderate facet and ligamentum flavum hypertrophy. Mild disc bulge. No significant spinal canal stenosis. Mild to moderate neural foraminal narrowing, left worse than right. L5-S1: Postsurgical change. Moderate facet and ligament flavum hypertrophy. Mild disc bulge with a small superimposed central protrusion. No significant spinal canal stenosis. Minimal to mild bilateral neural foramen stenosis.Abnormal areas of enhancement involving the sacral spinal canal at the S1 and S2 levels are not significantly changed and consistent with history of known ependymoma. No new or enlarging epidural tumor.
1. Compared to 2/19/2015 there is diffuse worsening of bone marrow signal with development of multiple new enhancing osseous lesions which are most apparent in the pelvis. Findings would be consistent with interval progression of osseous metastases/myelomatous involvement.2. No significant change in multiple chronic compression fractures.3. No significant change in residual enhancing tumor within the sacral spinal canal at the S1 and S2 levels compatible with known myxopapillary ependymoma.