Male, 17 years old, with history of locoregional synovial sarcoma of the spine with cardiac extension, surveillance imaging. Brain:A 5-mm non-enhancing focus of T2 hyperintensity in the right middle frontal gyrus has not significantly changed. Two or three punctate foci of susceptibility scattered through the brain are also unchanged. No other significant parenchymal signal abnormality is seen. No enhancing lesions are detected. There is no evidence of acute hemorrhage or any other abnormal fluid collections. The ventricles are normal in size and morphology.C-spine:Sequalae of C2-T2 laminoplasty and tumor debulking are again seen. Confluent enhancing left spinal and paraspinal tumor is redemonstrated spanning these levels with invasion of each neural foramen and minimal extension into the intraspinal epidural space. The overall bulkiness of this extensive lesion, and the degree to which it infiltrates the foramina, are stable compared to the immediate prior exam, and improved relative to older studies. Infiltrative tumor in the deep neck soft tissues adjacent to the spine has also decreased in size mildly. A collection seen previously in the left neck has resolved. Patchy heterogeneous marrow replacement throughout the cervical spine is unchanged. A progressive kyphotic curvature has developed at the cervico-thoracic junction. Vertebral body heights are preserved. The bony spinal canal is narrowed from C3-C7 which may in part be positional and in part due to scarring. There is mild cord flattening though this region without convincing cord signal abnormality. No cord or leptomeningeal enhancement is seen. The posterior paraspinal tissues are extensively scarred. T-spine:Patchy marrow replacement continues into the thoracic spine with involvement of the T1-T3 vertebral bodies. A focus in the T3 vertebral body is slightly larger than on prior exams, but these marrow abnormalities are otherwise unchanged. No other areas of concerning marrow signal are seen. Vertebral body heights are preserved. Spinal alingnment is anatomic. Below the laminoplasty levels, the spinal canal is widely patent. No additional paraspinal, foraminal or intraspinal tumor is seen. The spinal cord is normal in morphology and signal. Two nodules are present in the partially visualized right lung, the largest measuring up to 18 mm.
1.Redemonstrated are finding related to prior left spinal and paraspinal tumor debulking and C2-T2 laminoplasty. 2.The size and distribution of residual paraspinal and foraminal tumor is unchaged when compared to the immediate prior exam. Tumor is smaller when compared to older exams. 3.Heterogeneous marrow replacement of the cervical and upper thoracic vertebral bodies is seen compatible with treated tumor. A small focus of marrow replacement in the T3 vertebral body is slightly larger, but the remaining marrow lesions are not changed. 4.Right lung nodules are better assessed on chest CT.5.No convincing evidence of intracranial metastases. A focus of T2 hyperintensity in the right middle frontal gyrus, and scattered punctate foci of susceptibility, are non-specific and may be related to therapy.