Female, 61 years old, with left upper extremity weakness, assess cord edema and possible tumor. Please note that only precontrast images were obtained due to patient intolerance.Pathologic cord T2 hyperintensity and thickening is seen most conspicuously affecting the cord between C4 and C7. Abnormal signal without thickening extends superiorly to the C1 level and inferiorly to the T4 level. Findings are unchanged relative to the prior examination. At the levels of most prominent involvement, the internal architecture of the cord is obscured and there are small foci of very bright signal abnormality which may reflect cystic or cavitary tissue.The cervical lordosis is straightened. Vertebral body heights are preserved. Marrow signal characteristics remain within normal limits. Multilevel disc osteophyte formation is is seen in the cervical spine resulting in canal narrowing at C3-4, C4-5 and C5-6. However, minimal if any cord impingement or deformation is seen at these levels. Bulky facet arthropathy is demonstrated on the left at C2-3 and bilaterally at C3-4. Moderate to severe foraminal narrowing is seen on the left at C3-4 and on the left at C5-6. Minimal disc degeneration is present in the thoracic spine without significant spinal canal or foraminal compromise. Small bilateral pleural effusions are noted.
Examination was limited by patient tolerance which prevented acquisition of the postcontrast images. An extensive area of spinal cord signal abnormality is redemonstrated centered on the C4-C7 levels but with extension superiorly to C1 and inferiorly to T4. The internal architecture of the cord is obscured by this process and there is the suggestion of small areas of cord cavitation or cyst formation. A primary tumor of the cord remains high on the differential diagnosis with an inflammatory process considered less likely. 