[jfab1978]

T2 hyper-intense, T1 hypo-intense intramedullary lesions

by jfab1978 on Thu Feb 16, 2017 10:37 pm

Hello Everyone!

I'm hoping any of you wise folks on here can help us shed some light on a pretty terrifying situation.

My 40 year old husband went in last week for an MRI for lower back and hip pain. The technician flagged avascular necrosis of the right and left femoral heads and innumerable T2 hyperintense and T1 hypo-intense intramedullary lesions throughout the osseous structures. Findings are nonspecific but most concerning for metastatic disease. Multiple myeloma or an atypical infection could also be considered.

All lab test are in normal range, however the oncologist ordered a PET scan for tomorrow. Can anyone help us make any sense of this?

Kappa Light Chn 18.84 mg/L 3.3 - 19.4
Lambda Light Chn 17.97 mg/L 5.7 - 26.3
Kap-Lambda Ratio 1.05 0.26 - 1.65

C-Reactive Prot 4.0 mg/L 0.0 - 9.0
Total Protein 7.3 g/dL 6.4 - 8.2
Albumin 4.32 g/dL 3.2 - 5.6
Alpha 1 Globulin 0.41 g/dL 0.1 - 0.4
Alpha 2 Globulin 0.80 g/dL 0.4 - 1.2
Beta Globulin 0.74 g/dL 0.6 - 1.3
Gamma Globulin 1.02 g/dL 0.5 - 1.6

Lact Dehy (LDH) 179 U/L 85 - 227
Sodium 137 mmol/L 136 - 145
Potassium 3.8 mmol/L 3.5 - 5.1
Chloride 102 mmol/L 98 - 107
CO2(Bicarbonate) 26 mmol/L 21 - 32
Glucose 84 mg/dL 70 - 100
BUN 15 mg/dL 6 - 25
Creatinine 0.88 mg/dL 0.50 - 1.30
Calcium 9.6 mg/dL 8.2 - 10.2
Total Protein 7.8 g/dL 6.4 - 8.2
Albumin 4.2 g/dL 3.2 - 4.7
Total Bilirubin 0.6 mg/dL <1.1
Alkaline Phosph 106 U/L 26 - 137
AST 29 U/L 0 - 37
ALT 45 U/L 15 - 65

Wht Bld Cell Ct 4.1 K/uL 4.0 - 11.0
Rd Bld Cell Ct 5.20 M/uL 4.40 - 6.00
Hemoglobin 14.4 g/dL 13.5 - 18.0
Hematocrit 45.1 % 40.0 - 52.0
MCV 87 fL 80.0 - 100.0
MCH 27.7 pg 27.0 - 33.0
MCHC 31.9 g/dL 31.0 - 36.0
RDW 13.6 % <16.4 %
Platelet Count 188 K/uL 150 - 400
DifferentialType Automated
Neutrophil % 67 % 49.0 - 74.0
Lymphocyte % 19 % 26.0 - 46.0
Monocyte % 10 % 2.0 - 12.0
Eosinophil % 3 % 0.0 - 5.0
Basophil % 1 % 0.0 - 2.0
Abs. Neutrophil 2.8 K/uL 2.0 - 8.0
Abs. Lymphocyte 0.8 K/uL 1.0 - 5.1
Abs. Monocyte 0.4 K/uL 0.0 - 0.8
Abs. Eosinophil 0.1 K/uL 0.0 - 0.5
Abs. Basophil 0.0 K/uL 0.0 - 0.2

Thank you to whomever can help us shed some light. Blessings!

[Multibilly]

Re: T2 hyper-intense, T1 hypo-intense intramedullary lesions

by Multibilly on Fri Feb 17, 2017 9:21 am

Hi jfab1978,

The good news is that nothing in the lab results you posted suggests multiple myeloma, at least to me. But since the MRI revealed numerous lesions, it makes sense to do a PET/CT as the next step to confirm if any of these lesions are cancerous or not. If the PET/CT shows that they are cancerous, then the doctor would likely next order a bone marrow biopsy to determine what the underlying cause of the lesions are.

While it is not common, there is a form of multiple myeloma known as non-secretory multiple myeloma where the disease will not show up in any blood tests, but only in the bone marrow, where it can still cause bone damage.

The PET/CT will be telling and you should be able to get the results back from the radiologist in a day or two after you have the PET/CT scan performed.

Good luck and let us know how things turn out.