 BRAIN: Thin section postcontrast images are limited by patient motion artifact and are essentially nondiagnostic.There has been interval enlargement of the previously identified left cerebellar FLAIR hyperintense lesion with central punctate enhancement, which now measures 12 x 11 mm, with associated mild mass effect. Other scattered nonspecific foci of enhancement in the bilateral cerebellar hemispheres with subtle FLAIR hyperintensity are stable to slightly increased in conspicuity when allowing for differences in technique.There is a stable 19 x 16 mm high left anterior parietal high CSF signal intensity oval structure with mild mass effect upon the adjacent parenchyma and mild overlying calvarial remodeling. There is mild mass effect upon the subjacent parenchyma. There is no diffusion restriction. There is no midline shift or extra-axial fluid collection.There is mild mucosal thickening in the maxillary sinuses with scattered left greater than right ethmoidal thickening. Trace mucosal thickening is also noted in the right sphenoid sinus. There is prominence of the palatine tonsils bilaterally, which are nonspecific but likely represent reactive lymphoid tissue in a patient of this age. There is also enlargement of the right node of Rouviere which measures 13 mm in length, also possibly reactive.SPINE: Images are somewhat limited by patient motion especially postcontrast images. There is redemonstration of a tiny linear focus of enhancement at the T2 level within the dorsal aspect of the cord, slightly to the left of midline although this again cannot be confirmed on axial imaging due to motion artifact.There is grossly stable subtle linear high T2 signal abnormality in the left paramedian dorsal aspect of the cord at the T6 level again associated with ill-defined enhancement. There is persistent expansion and prominent high T2 signal abnormality within the thoracic cord beginning superiorly at the T8-9 level, extending inferiorly to the T11-12 level. There is a subcentimeter associated intramedullary enhancing nodule along the posterior aspect of the thoracic cord centered at T10-11 disk space, not as well delineated on the current exam on axial images secondary to motion artifact, although it appears grossly similar on sagittal images.The spine is in normal alignment. The vertebral body and disk heights are well-maintained. There is a 6-mm nonaggressive appearing enhancing lesion in the posterior inferior T9 vertebral body which is nonspecific, with corresponding T2/STIR hyperintensity and T1 hypointensity. A smaller T1 hyperintense lesion is again seen with peripheral lower signal in the T6 vertebral body superiorly. The distal spinal cord and conus are within normal limits with the conus terminating at the L1 level.There stable mild disc height loss and desiccation at T11-12 with mild disk bulging and tiny annular fissure. There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the remainder of the spine. There are numerous cystic masses in the pancreas and kidneys. Please refer to the separately dictated report for MRI of the abdomen of the same date for further details.
1. Motion limited exam. Grossly stable enhancing nodule in the dorsal thoracic cord centered at T10-11 level with extensive nonenhancing T2 cord hyperintensity at least in part relating to cord edema. Differential is unchanged, again concerning for spinal cord hemangioblastoma provided patient's history of VHL.2. Grossly stable additional nonspecific T6 and T2 cord lesions with suspected enhancement. Continued follow-up is recommended.3. Interval increased size of a left cerebellar FLAIR hyperintense lesion with punctate central enhancement, now with mild localized mass effect, suspicious for a hemangioblastoma. A few other stable to very minimally increased in conspicuity scattered punctate enhancing lesions with associated T2 hyperintensity within the cerebellum bilaterally.