FINDINGS: This exam was compared to the MRI dated October 12, 09.
As shown previously, there is "bow-tie" loss of height involving the L3 vertebral body without associated bone marrow edema ( concavity of the superior and interior endplates) consistent with a chronic compression fracture. The shape of the fracture and associated diffuse heterogeneous mottled decreased T1 and T2 bone marrow signal with associated heterogeneous post-contrast enhancement.of the bone marrow is consistent with fracture secondary to myeloproliferative disease such as multiple myeloma or metastatic adenocarcinoma from breast or lung. Clinical correlation is highly recommended to rule out a neoplastic process. The compression fracture and bone marrow signal characteristics are not typical of osteopenia versus osteoporosis. In particular, there is not consistent with an insufficiency fracture. There is no displaced fracture fragment. The neural canal is widely patent. There has been slight worsening of the loss of height, with the central (narrowest) portion of the vertebral body measuring 1.0 cm on the sagittal cuts, compared to 1.4 cm on the previous study.
There is slight (approximately 30%) loss of height of the L5 vertebral body without increased T2 signal, also consistent with a mild compression fracture, which is not present on the previous exam. There is no displaced fracture fragment.
The remainder of the vertebral body heights and alignment are within normal limits. The disk space heights are normal. The neural canal and neural foramina are widely patent, there is no evidence of nerve root impingement or cauda equina, conus medullaris, or cord impression.
Developmentally, the spinal canal volume is normal. The cauda equina, conus mdeullaris, and distal spinal cord show no abnormal mass, signal, or post-contrast enhancement. In particular, there is no evidence of intrathecal metastatic disease.
The facet joints are normal. There is no evidence of spondylolysis or spondylolisthesis.
IMPRESSION: Bone marrow signal and shape of the loss of height/compression fracture of the L3 vertebral body are highly consistent with primary versus metastatic bone marrow disease such as multiple myeloma or metastatic adenocarcinoma. Clinical correlation is advised. Loss of height on the L3 vertebral body is slightly worse compared to the exam dated October 12, 2009, however, there is no associated bone marrow edema, suggesting a chronic healed compression fracture. Considering the signal characteristics, shape of the compression fracture, and bone marrow signal finding, this is not typical of an insufficiency compression fracture fragment. The neural canal and neural foramina are widely significant retropulsed or unstable fracture fragment. The neural canal and neural foramina are widely patent. The post-contrast enhancement of the bone marrow suggests a persistent active process.
Slight loss of height (approximately 30%) of the L5 vertebral body without increased T2 signal, also consistent with a mild compression fracture, which is not present on the previous exam. There is no displaced fracture fragment.
The remainder of the exam is unremarkable.
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