Male, 35 years old, history of ependymoma of the spine status post resection with supratentorial lesions. Brain:A punctate focus of cortical enhancement is seen along the left precentral sulcus (image 128 series 37). The immediate prior examination was performed without contrast, but when compared to the next prior examination, the size of the enhancement has decreased. T2 hyperintensity which extends from this lesion and spreads mildly into the adjacent white matter is unchanged relative to the immediate prior study, but more prominent than that seen on the older study.An enhancing lesion seen previously in the right occipital lobe has decreased in size and now presents as a faint ill-defined blush (image 79 series 37). A punctate focus of enhancement in the left occipital lobe (image 77 series 37) was not clearly evident on the prior contrast enhanced exam although image quality in that study was poor.No evidence of significant parenchymal edema or mass effect is seen. No intracranial hemorrhage or any abnormal extra-axial fluid collection is detected. Ventricles are normal in size and morphology.Spine:Motion artifact significantly degrades image quality in the spine.Redemonstrated is evidence of laminectomy from C6 through T2. The soft tissues of the operative bed are diffusely enhancing compatible with scar. No fluid collections are seen.Redemonstrated is evidence of tumor resection from the lower cervical/upper thoracic spinal cord. The cord is thinned from C7 through T2, and in this region, the cord does enhance diffusely but to a lesser degree than was seen on the prior contrast enhanced study. As before, the inferior margin of this enhancement appears to stop at a hemosiderin cap.Syringohydromyelia of the cord above the level of resection is unchanged. Within the limitations of degraded image quality, no other lesions are suspected in the visualized spinal canal.A small left pleural effusion is evident.
1. Two of the intracranial enhancing lesions seen on the prior examination have decreased in size. This includes a lesion along the left precentral sulcus. T2 hyperintensity which extends from this lesion into the adjacent white matter is unchanged relative to the immediate prior examination, but more prominent when compared to older studies. These changes would be compatible with evolution of a benign process, perhaps embolic or septic-embolic disease. However the possibility of metastasis has not been entirely excluded and continued follow-up of these lesions is recommended.2. A single punctate lesion in the left occipital lobe visualized on the present study was not clearly seen on the prior contrast enhanced examination. It is possible that this lesion was present and simply not seen due to significant artifact on the prior study, though it could have developed in the interval. There is no associated T2 hyperintensity or edema. The significance of this finding is uncertain.3. Redemonstration of postoperative findings in the spine compatible with resection of ependymoma from the lower cervical and upper thoracic spinal cord. The cord remains thinned through this region and diffusely enhancing. However, the intensity of enhancement is reduced relative to the prior study. No definite evidence of any new cord lesion is seen within the limits of significant artifact.