Clinical question: Rule out leptomeningeal enhancement. Signs and symptoms: Cauda equina enhancement, gait problem. Pre and postcontrast enhanced lumbar MRI:Examination demonstrates mild diffuse uniform enhancement of cauda equina without definitive evidence of interval change since prior exam. There is no evidence of clumping of cauda equina and no detectable focal regions of thickening which is a similar observation is prior study. There is no detectable signal abnormality of the conus.Diffuse T1 hypointensity and T2 STIR hyperintensity with mild diffuse enhancement of all visualized bony structures remain similar to prior exam.Diffuse uniform marrow signal change (T1 hypointense, T2 and T2* hyperintense) and enhancement of vertebral body of T12 similar to prior examination without evidence of fracture or malalignment and suggestive of metastatic disease.Extensive degenerative changes of lumbar spine without significant interval progression. Mild to moderate central spinal stenosis at L2-L3 and L4-L5 levels remain very similar to prior exam. Also multilevel neural foraminal compromise some significantly demonstrate no definitive change.
1.No evidence of acute or convincing evidence of new finding since prior exam.2.Uniform diffuse enhancement of cauda equina without clumping or thickening of cauda equina similar to prior exam. This finding likely representing post treatment change considering its stable status since lumbar MRI exam from 2011. Correlation with CSF analysis is recommended.3.No detectable signal abnormality of the lower most visualized thoracic cord or the conus.4.Diffuse uniform marrow signal changes of the entire visualized bony structures with uniform mild enhancement likely representing posttreatment findings and without interval change.5.Increased T2 STIR signal intensity of T12 vertebra with uniform enhancement similar to prior exam and likely representing a stable metastatic lesion without interval change since prior exam.6.Stable extensive degenerative changes of lumbar spine with a spinal stenosis and neural foraminal compromise since prior study.