Reason: CNS involvement of AML? meningeal enhancement? History: headache, cervical spine tenderness, relapsed AML Brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a focus of diffusion restriction present along the splenium of the corpus callosum. This is associated with T2 and flair signal hyperintensity. There is no associated contrast enhancement.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses and demonstrate some mucosal thickening in the left maxillary sinus, sphenoid sinuses and ethmoid air cells and near complete opacification of the right maxillary sinus. The visualized portions of the mastoid air cells demonstrate scattered opacities. The visualized portions of the orbits are intact.Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord demonstrates a small syrinx at the C6 and C5 vertebral body levels measuring up to 1.5 mm in diameter. No abnormal enhancing lesions are identified in the cervical spine. The marrow signal generaly diminished.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.
1. A lesion in the splenium of the corpus callosum is nonspecific . Often times these lesions are reversible. They have been associated with influenza, chemotherapy treatment and seizure.2. there is opacification of the right maxillary sinus with an obstructive pattern suggestive of obstruction of the right ostiomeatal complex unit or hiatus semilunaris.3. Small spinal cord syrinx.4. Periventricular and subcortical white matter signal changes of a mild degree are present which are nonspecific. They could be vascular related, related to demyelination, trauma, vasculitis, sarcoid. They are nonspecific. 5. Finding suggests diffuse marrow replacement. In the context of acute myeloid leukemia this may be related to myeloproliferation.