43 years, Female, paresthesias and history of multiple sclerosis, evaluate for progression.. Brain:There are innumerable foci of T2/FLAIR hyperintensity in the bilateral periventricular and subcortical white matter in morphology and distribution consistent with known demyelinating disease. Numerous lesions with T1 hypointensity are also noted. There is also moderate degree of brain parenchymal loss including thinning of the corpus callosum. Few infratentorial lesions are also again seen. Abnormal signal involving the bilateral optic nerves is also suspected although would be better assessed with dedicated orbital imaging if clinically indicated. Compared to 11/1/2010, there appears to progression with multiple new or larger areas of T2/FLAIR hyperintensity at the left posterior frontal operculum, left frontal cingulate gyrus, left inferior parietal lobule, right frontal subcortical and periventricular white matter, posterior limb of the right internal capsule, right supramarginal gyrus, and right lateral occipital lobe.No intracranial mass or mass effect. No hydrocephalus. Calvarium and extracranial soft tissues are grossly unremarkable. Cervical spine:There are multiple T2 hyperintense lesions throughout the cervical cord affecting all levels and consistent with known demyelinating disease. Subtle areas of volume loss are seen such as at the dorsal C3 level, although overall cord parenchymal volume is grossly preserved.Vertebral body heights and alignment are maintained. Small disc osteophyte complexes and uncovertebral hypertrophy are noted at C3-C4, C4-C5, and C5-C6. There is no significant spinal canal stenosis. There is up to moderate right C3-C4, right worse than left C4-C5, and left worse than right C5-C6 neural foraminal stenoses. Bone marrow signal is benign. Paraspinous soft tissues are unremarkable.
1. Numerous T2/FLAIR hyperintense lesions in the brain compatible with known demyelinating disease. Several new T2/FLAIR hyperintense lesions in the brain are seen compared to 11/1/2010 as described above and compatible with progression of demyelinating disease.2. Moderate degree of brain parenchymal volume loss including thinning of the corpus callosum.3. T2 hyperintense lesions throughout the cervical cord also consistent with known demyelinating disease. No prior cervical spine MRI is available for comparison.4. Degenerative changes in the cervical spine with neural foraminal narrowing at C3-C4, C4-C5, and C5-C6 as above.