Clinical question: Non-Hodgkin's lymphoma with CNS involvement status post chemotherapy. Signs and symptoms: Restaging. Pre- and post enhanced complete spine MRI:Cervical spine images demonstrate normal signal intensity and alignment of vertebral column without abnormal enhancement. Normal signal intensity and caliber of cervical cord and without abnormal enhancement.No significant degenerative disease or spinal stenosis at any level is detected. There is revisualization of very faint thin smooth enhancement of few of the cervical nerve roots bilaterally in a symmetrical fashion without detectable thickening of the nerve roots is again noted. Finding is nonspecific however less likely possibility of tumor cannot be entirely excluded. There is no detectable enhancement of the leptomeningeal lining of the cervical cord.Thoracic spine images demonstrate normal alignment of vertebral column without abnormal enhancement. There is uniform marrow signal changes of the lower thoracic spine similar to prior exam and likely representing postradiation change. This finding extends from T10 inferiorly through the sacral spine and consistent with prior radiation change.There is revisualization of a stable focus of intradural extra medullary enhancement (axial series 13 image 25) in the left lateral thecal sac at T5 level measuring approximately 5 mm at the base along the dura and 5 mm in transverse axis similar to prior exam in size, density and extent. Differentials of a nerve sheath tumor or small focus of metastatic disease should be considered.There is no convincing evidence of any additional foci of abnormal leptomeningeal enhancement. This is a similar observation is prior study.No evidence of a spinal stenosis or neural foraminal compromise at any level.Lumbar spine images demonstrate uniform diffuse marrow signal changes of the vertebral column consistent with prior radiation therapy. There is subtle enhancement of the endplates abutting the L2-L3 disc representing degenerative changes. Finding was also noted on prior exam and without change.The signal intensity and morphology of the lower most visualized thoracic cord, conus and cauda equina is within normal.On post enhanced images there is uniform faint enhancement of cauda equina without detectable clumping, focal areas of thickening or tumor. This finding was not as conspicuous on prior exam which likely is techniques related. Finding could represent posttreatment changes however correlation with CSF analysis is recommended to exclude less likely possibility of leptomeningeal carcinomatosis.
1.Cervical MRI demonstrate smooth thin symmetrical faint enhancement along the nerve roots without significant change since prior exam. Unremarkable cervical MRI otherwise. The signal intensity and caliber of cervical cord is within normal and without detectable enhancement of its leptomeninges.2.Thoracic MRI demonstrates a single stable focus of intradural extra medullary enhancement ( 5 x 5 mm) in the left lateral aspect of spinal canal at T5 level. Differentials of isolated focus of the meningeal tumor or a nerve sheath tumor should be considered. No detectable additional foci of leptomeningeal enhancement.3.Lumbar MRI demonstrate smooth uniform thin enhancement of the cauda equina without focal thickening of clumping. This finding was not as conspicuous on prior exam which could be technique related. To entirely exclude leptomeningeal carcinomatosis follow up with CSF analysis is recommended. 