 Cervical images are somewhat limited by patient motion. Within these limitations, post contrast images demonstrate numerous areas of abnormal enhancement, including a few foci within the right inferior cerebellum as seen on prior brain MRI. There is redemonstration of leptomeningeal enhancement along the left greater than right cerebellar sulci. In addition, there is patchy intramedullary cord enhancement most conspicuous along the right ventral C6 level, as well as areas of leptomeningeal enhancement scattered along the cord surface along its entire length. There is a small area of intrinsic T2 hyperintensity within the midline ventral cord at the mid T8 level with enhancement. There is also T2 abnormality along the left ventral aspect of the cord at the T9-T10 and mid T11 levels with enhancement. There is also similar abnormality along the left dorsal mid T12 level. Focal enhancing nodules also seen along some of the distal cauda equina nerve roots caudal to the L3-L4 level. There is focal 5 x 4 mm nodular enhancement in the right lateral thecal sac L1-L2 level presumably associated with a nerve root.The spine is in normal alignment. There is mild disk narrowing at L5-S1 with mild scattered lumbar disk desiccation. The vertebral body and disk heights are otherwise well-maintained. There is a mildly heterogeneous appearance of the marrow signal especially in the cervical and thoracic spine which is nonspecific. The spinal cord is of normal caliber. The distal spinal cord and conus are within normal limits with the conus terminating at the mid L2 level.Throughout the cervical spine, there are mild disk bulges with rightward predominance. There is minimal ligamentum flavum thickening at C5-C6 and C6-C7. There is mild central spinal canal stenosis at C5-C6. There is mild right foraminal narrowing at C3-C4 and C4-C5, as well as bilaterally at C5-C6.There is a trace disk bulge at L2-L3 with left paramedian annular fissure and shallow left foraminal disk protrusion. There is resultant mild/moderate left foraminal narrowing. Additional trace disk bulges noted at L4-L5 with small left distal foraminal/fat lateral annular fissures. Small central annular fissure is also present at L5-S1 with shallow right paracentral disk protrusion which abuts the descending right S1 nerve root.There is moderate fluid opacification of bilateral mastoid air cells.
1. Diffuse leptomeningeal disease within the spinal canal, with scattered early areas of intramedullary metastatic disease identified along cervical and lower thoracic spine which may in part relate to direct extension from areas of leptomeningeal tumor.2. Redemonstration of known leptomeningeal and parenchymal metastatic disease in the posterior fossa.3. Nonspecific heterogeneous appearance of the marrow signal.4. Mild scattered cervical and lumbar spondylotic changes as detailed above.