Image 1

Clinical History: 
Back pain in a 58 year old woman

Diagnosis:
Multiple myeloma

MR Technique: 
3 mm sagittal FSE T1- and T2-weighted images of thoracic spine are illustrated, obtained at 1.5 T using a Siemens Espree MR system. Imaging parameters were TR/TE = 565/10 and 3120/106, with scan times of 3:33 and 3:30, respectively.

Imaging Findings:
On the T1-weighted image there is diffuse low signal intensity within the visualized marrow (the normal marrow should be higher signal intensity than the intervertebral disks on a T1-weighted scan). In a patient with a known diagnosis of multiple myeloma who has not yet begun chemotherapy, these findings are consistent with widespread metastatic disease/marrow infiltration associated with myeloma. An anterior wedge deformity is noted at T8 with approximately 50% loss of vertebral body height anteriorly. There is question of a discrete fracture line in the superior portion of the vertebral body, which would indicate an acute compression fracture. The appearance of multiple myeloma on MR can be quite varied, with the spectrum of appearance spanning from no visualized disease, to focal disease, to diffuse involvement (as illustrated). Focal disease also spans the spectrum from a salt & pepper appearance to multiple focal lesions > 5 mm in size. Epidural spread of disease is common, but was not seen in the patient illustrated.