9-year-old female with history of relapsed neuroblastoma presenting with right lower extremity numbness and tingling. Brain:The ventricles and sulci are within normal limits. The cisterns remain patent. There is no midline shift or mass effect. There are no areas of abnormal signal or pathological enhancement within the brain. There is no diffusion abnormality. No extra-axial fluid collection is identified. There is heterogeneous bone marrow signal throughout the skull with a few areas of focal signal abnormality such as in the left frontal bone where there is enhancement suspicious for metastases. No large lesions or evidence of epidural tumor.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits.  Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. There is a mottled appearance to the marrow of the cervical spine associated with some foci of signal loss and some vertebrae. Small focus of contrast enhancement is present along the posterior and right aspect of the odontoid of the C2 vertebra. There is an enhancing lesion present between the spinous processes of C7 and T1 measuring 12 x 8 mm on sagittal images, eccentric to the left side.The cervical spinal cord has normal signal characteristics and overall morphology.There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the cervical spine.The vertebral artery flow voids appear to be intact.MRI thoracic spine:The thoracic vertebral bodies are appropriate in the overall alignment. There is mild loss of vertebral body height at T6 and T10, compatible with pathologic fracture. There is a heterogeneous signal present within the upper thoracic vertebrae. There is T1 signal hyperintensity throughout the vertebrae most prominent at T1, T5, T10, T11 and T12. There is contrast enhancement within T6, T8, and T10 centrally.There are multiple enhancing paravertebral lesions present along the thoracic spine. One located to the left of the T2 vertebral body measures 18 x 9 mm on axial images and one to the right of the T2 vertebral body measures 8 x 13 mm axial images (series 55 image 6). There is a 30 x 13 mm lesion to the left of the T4 vertebral body, which enters the left T4-5 neural foramen and mildly effaces the posterior left epidural space (series 55 image 12). There is also evidence of mild epidural tumor at the T8 level. The thoracic spinal cord has normal signal characteristics and overall morphology. There are 2 lesions in either side of the T3 spinous process present measuring 18 x 11 mm on the right and 13 x 22 mm on the left in axial dimensions. Multiple additional smaller lesions are present between spinous processes of other levels throughout the thoracic spine.There is no significant disk bulge or herniation throughout the thoracic spine.Lumbar spine:The lumbar vertebral bodies are normal in overall alignment and height. The conus medullaris and distal spinal cord are normal. There are contrast enhancing foci present at L4. There is T1 signal hyperintensity throughout the L1 and L2 vertebrae. This is suspected represent radiation effect. There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the lumbar spine. There are marrow replacing lesions present within the iliac bones and sacrum. An enhancing lesion is present in the left half of the sacral spinal canal, which is incomplete visualized on today's examination. The tumor involvement along the left sacral nerve roots was better appreciated on the previous examination. The left presacral lesion is partially visualized.
1. Extensive paraspinal and osseous spinal metastases, similar to the prior examination. Metastatic lesions at T4-5 and T8 levels again demonstrate mild epidural extension. Neural foraminal tumor is most conspicuous at the left T4-T5 level. No evidence of significant cord compression, abnormal cord signal, or metastatic spinal cord lesion.2. No evidence of intracranial metastatic disease. Nonspecific heterogeneous bone marrow signal and enhancement in the calvarium, which could relate to metastatic involvement, particularly of the left frontal bone.3. Partially visualized small left-sided epidural lesion within the left sacral spinal canal with evidence of involvement of the left sacral nerve roots better evaluated on prior examination. Lumbar spinal canal and lumbar neural foramina are patent.