Patient with lymphoma on intrathecal rituximab Thoracic: Cervical nerve root enhancement including the right C5 and left C8 nerve roots is better seen on earlier cervical MRI from 10/5/2016. There is abnormal enhancement involving the bilateral T1 and to a lesser degree T2 nerve roots which is stable to mildly decreased since 8/5/2016. Cervical and upper thoracic nerve root enhancement is particularly improved when compared to 3/8/2016 study.There also appears to be abnormal enhancement involving the multiple thoracic nerve roots in the mid and lower thoracic spine and not significantly changed since 8/5/2016. Exaggerated thoracic kyphosis is unchanged. Sagittal alignment is otherwise anatomic. Vertebral body heights are preserved. Scattered small Schmorl's nodes again seen. No suspicious osseous lesions. The visualized spinal cord shows normal signal intensity and morphology and is free of pathologic enhancement. No significant spinal canal or foraminal stenosis is seen. The right kidney is not visualized and the left is large, similar to prior.Lumbar: Vertebral body heights and alignment in the lumbar spine are normal. There are no suspicious osseous lesions. Edema and enhancement involving the left aspect of the L3 vertebral body is nonspecific and may be on a degenerative basis. Mild multilevel degenerative changes include small disc bulges throughout the lumbar spine without significant spinal canal stenosis. Small annular fissures are also present including the L3-L4 and L4-L5 levels. There is mild left L3-L4, mild right L4-L5, and mild bilateral L5-S1 neural foraminal stenosis. There is also mild to moderate multilevel facet arthropathy.There is no evidence of epidural tumor. There is diffusely increased enhancement and thickening involving the lumbar and partially imaged sacral nerve roots extraforaminally. There is also mild enhancement of the cauda equina nerve roots allowing for slight differences in technique. There is overall no significant change since 8/5/2016.
No findings to suggest lymphoma progression in the thoracic or lumbar spine. Again seen is abnormal enhancement and thickening involving multiple thoracic and lumbar nerve roots extraforaminally as well as mild enhancement involving the cauda equina nerve roots. These findings are not significantly changed since 8/5/2016 allowing for slight differences in technique. No suspicious osseous lesions or epidural tumor. 