21 years, Male, GBM of the spinal cord S/P chemo and RT (last day Oct 3, 2016). Brain: Brain parenchyma appears within normal limits. There is no significant parenchymal signal abnormality or intracranial mass is evident. There is a small extra-axial collection at the ventral craniocervical junction extending into the retroclival region without significant mass effect on the ventral brainstem. No midline shift or herniation. No abnormal parenchymal or meningeal enhancement. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. The ventricles are within normal limits in size and configuration. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. There is minimal scattered paranasal sinus mucosal thickening. Bone marrow signal and extracranial soft tissues are within normal limits. Cervical spine: Postsurgical changes of biopsy and C1-C5 laminectomy are seen in the interval. There is an expansile lesion with T2 hyperintensity centered at the C2-C4 levels with mild T2 hyperintensity superiorly extending to the C1 level. Compared to prior MRI from 7/19/2016, there appears to be decrease in overall cord swelling and decrease in the very high T2 signal reflective of decrease in vasogenic edema component of the lesion, with the residual T2 signal abnormal likely primarily reflect infiltrating tumor. There are more discrete cavitary/necrotic areas involving the cervical cord at the C2-C3 level which may reflect postbiopsy change. There is also interval increase in more solid-appearing enhancement involving the primarily the dorsal aspect of the cord from the mid C2 to the mid C3 levels as well as mild patchy enhancement involving the right ventral and right lateral aspects of the cord at the C2 and C3 levels.Cord signal abnormality extends to the inferior C4 level. More inferiorly there is diffusely increased epidural enhancement likely reflecting reactive, post treatment changes. No significant spinal canal stenosis is evident.There is a small postop fluid collection posterior to the dura measuring up to 7 mm in thickness and extending from the C1-C3 levels. No associated mass effect on the cord.Thoracic spine: There is mild, diffusely increased enhancement involving the epidural space in the thoracic spine which is favored to be reactive and related to posttreatment change. No discrete nodular enhancement or mass within the thoracic spine is evident.The thoracic spine is in normal alignment. The vertebral body and disk heights are well maintained. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal.There is developmental narrowing of the thoracic spinal canal. There is otherwise no significant disk bulge, herniation, spinal canal or foraminal stenosis within the thoracic spine.
1. Postoperative changes related to biopsy of enhancing cervical cord tumor centered at the C2-C3 level consistent with known glioblastoma. Compared to 7/19/2016 there appears to be decrease in vasogenic edema in the cervical cord and increase in areas of solid and patchy enhancement from the mid C2 to the C3-C4 levels. These findings may reflect post treatment change given recent chemoradiation, although progressive tumor is not entirely excluded.2. No evidence of direct tumor extension or metastasis in the brain or thoracic spine.