 Brain: Brain parenchyma appears unremarkable. No intracranial mass or abnormal enhancement to suggest hemangioblastoma. No evidence of infarct or hemorrhage. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. Mild scattered paranasal sinus mucosal thickening again seen, slightly worse involving the right anterior ethmoid sinuses. No findings to suggest endolymphatic sac tumor. Calvarium and remainder of the extracranial soft tissues are grossly unremarkable.Spine: CERVICAL: Linear enhancement along the posterior medial aspect of the cord related to vascular ectasia. Nodular focus of enhancement measuring 3 mm along the dorsolateral aspect of the spinal canal at the right C7 level compatible with hemangioblastoma remains unchanged. Tiny nodular focus along the left lateral aspect of the spinal canal along intradural nerve at the C3 level also unchanged. No new or enlarging lesions.Mild degenerative changes in the cervical spine including mild left neural foraminal narrowing at the C5-C6 level is unchanged. Spinal canal is patent. Vertebral body heights and alignment are maintained. No cord signal abnormality.THORACIC: 3 to 4 mm nodular foci of enhancement at the T1 level bilaterally suspected to represent tiny hemangioblastomas along the intradural aspect of the nerve rootlets and unchanged. Additional foci along the intradural spinal nerve rootlets including at the T4 on the right, the T4-5 level on the left, the T5 level on the right, as well as numerous foci along the conus. These lesions are unchanged in size and no new lesions are appreciated. Findings compatible with vascular ectasia are also seen along the dorsal and ventral surface of the distal spinal cord and conus.Alignment is anatomic. Vertebral body heights are preserved. No concerning marrow signal change is demonstrated.Spinal cord signal intensity and morphology are normal throughout. No significant spinal canal or neuroforaminal narrowing is demonstrated. LUMBAR: Numerous intradural enhancing nodules are redemonstrated along the nerve roots of the cauda equina. The largest of these is at the L1 level and measuring up to 15 x 15 mm in the axial plane and 17 mm in the craniocaudal dimension, which is unchanged, previously 15 x 15 x 16 mm on 5/11/2015. There is gradual enlargement when compared to examination dating back to 6/21/2013 when this lesion measured 11 x 12 x 12 mm. The other nodules including a relatively more prominent 7 mm nodule at the upper L3 level are also unchanged including numerous punctate foci along the distal nerve roots. No definite evidence of any new lesions is seen.Alignment is anatomic. The vertebral body heights are preserved. No concerning marrow signal change is demonstrated.Mild degenerative changes include mild to moderate right L4-L5 neural foraminal stenosis related to a small disc protrusion which appears minimally more prominent in the interval. Disk desiccation at the L5-S1 level with small disc protrusion at the left L5-S1 level with contact of the left S1 nerve root in the lateral recess is similar to prior. Spinal canal neural foramina and lumbar spine are otherwise preserved.Enhancing retroperitoneal lesion along the lateral aspect of the left 12th rib measuring approximately 10 x 12 mm is unchanged. 11 mm lesion at the aortic bifurcation is also unchanged. Additional abdominal findings including renal cysts and evidence of bilateral adrenalectomy again seen and better assessed on prior dedicated abdominal MRI.
1. No evidence of intracranial lesions.2. Multiple hemangioblastomas in the cervical, thoracic, and lumbar spine are overall not significantly changed since MRI from 5/11/2015. The more dominant mass at the L1 level measuring 15 x 15 x 17 mm demonstrates gradual enlargement as detailed above.3. No significant change in enhancing nodules in the left retroperitoneal region as well as at the aortic bifurcation.4. Mild degenerative changes in the lumbar spine with disc protrusions at L4-L5 and L5-S1 levels as described above.