Clinical question: Please perform Dr.Javed's MS protocol and compared to prior exam. Signs and symptoms: Progression of multiple sclerosis. Pre-and post enhanced brain MRI:This examination is performed utilizing Dr, Javed's dedicated multiple sclerosis protocol.Examination demonstrates extensive supratentorial parenchymal white matter chronic findings of multiple sclerosis without evidence of enhancement.There is interval change in the appearance of the findings compare to prior exam secondary to interval evolution of previously noted larger enhancing lesions. There is however no convincing evidence of progression of disease since prior study. Note should be made that the very large number of lesions and also significant technique difference between the two exams makes precise comparison less accurate. This is a similar observation is exam.Mild prominence of the lateral ventricles with maintained midline a similar to prior exam.Pre-and post enhanced cervical MRI:There are no prior exams of the cervical spine for comparison.Examination demonstrates at least two well identified foci of T2 hyperintensity of the cervical cord suggestive of demyelinating disease. Findings are located posteriorly at the cervicomedullary junction of the cord and posteriorly at C3 level. Axial T2 weighted series also demonstrate a lesion in the midline and extending posteriorly at C6 and C7 disk level. There is limited view of upper thoracic spine also demonstrates focal areas of T2 hyperintensity at T1 on the right and larger lesion at T1 -- T2 disk level occupying most of the cord.There is no appreciable change in the cord caliber secondary to these findings and no detectable abnormal enhancement.
1.Pre-and post enhanced brain MRI demonstrate no evidence of an enhancing plaque and without convincing evidence progression of disease since prior study. There is suggestion of decreased size of a few of previously noted larger plaques suggestive of interval evolution to chronic state.2.Pre-and post enhanced MRI of the cervical spine demonstrate multiple nonenhancing lesions of the cervical cord and uppermost visualized thoracic cord as detailed. Findings consistent with chronic demyelinating disease and without resultant change in the caliber of the cord or abnormal enhancement. There are no prior exams for comparison.