Spinal bone marrow AML recurrence
44-year-old with relapsed AML 100 days post allograft SCT for myelodysplasia converted to AML. New complaint of lumbar back pain radiating to the base of the skull. Evidence of CNS disease?
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Apart from the known superior endplate depression and Schmorl nodule of L4, the vertebral bodies have normal height and alignment. There is diffuse bone marrow signal abnormalities characterized by low T1 and T2 signal and patchy punctate foci of enhancement that are suggestive for bone-marrow infiltration by leukemic cells. A more prominent nodular enhancement within the superior endplate of L4 seems to be also disease related rather than an acute Schmorl nodule. The spinal canal and intervertebral foramina are capacious, with no areas of high-grade stenosis. The cord has normal morphology and signal intensity, with no abnormal enhancement. Paravertebral soft tissues are unremarkable.
This case shows diffuse bone marrow signal abnormalities in keeping with disease recurrence (acute myeloid leukemia). There are no signs of cord involvement or canal stenosis.