9 years Female (DOB:3/28/2007)Reason: 9 yo F h/o neuroblastoma now with relapsed disease with paraspinal lesions History: back and leg pain worst on right, no neurologic symptoms PROVIDER/ATTENDING NAME: JILL L. O. DE JONG JILL L. O. DE JONG Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. There is a mottled appearance to the marrow of the cervical spine associated with some foci of signal loss and some vertebrae. Small focus of contrast enhancement is present along the posterior and right aspect of the odontoid of the C2 vertebra. There is an enhancing lesion present between the spinous processes of C7 and T1 measuring 12 x 8 mm sagittal dimensions. It is eccentric to the left side.The cervical spinal cord has normal signal characteristics and overall morphology.No abnormal enhancing lesions are appreciated in the cervical spine.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.MRI thoracic spine:The thoracic vertebral bodies are appropriate in the overall alignment and height. There is mild loss of vertebral body height at T6 and T10. There is a heterogeneous signal present within the upper thoracic vertebrae. There is T1 signal hyperintensity throughout the vertebrae. T5, T10, T11 and T12 as well as the upper lumbar spine. There is contrast enhancement within T10 in the T8 centrally.There are enhancing paraspinous lesions present along the thoracic spine. One located to the left of the T2 vertebral body measures 18 x 9 mm axial dimensions. One to the right of the T2 body measures 8 x 13 mm axial dimensions. There are 2 lesions in either side of the T3 spinous process present one on the left measures 18 x 11 mm whereas the one on the right measures 13 x 22 mm there is a 22 x 12 mm axial dimensions. Additional smaller lesions are present between the spinous processes of the T1 and T2 as well as between the spinous processes of T4 and T5. The one at T4-5 is associated with a small soft tissue lesion to the left of the spinous process.There is a lesion to the left of the T4 vertebral body and the smaller one to the right of the T4 vertebral body measuring 12 x 7 mm axial dimensions. The lesion to the left of the T4 vertebral body and is the left T4-5 neural foramen and appears to mildly displace the thecal sac towards the right side. There is a 8 x 12 mm lesion to the right of the T7 vertebra and another one adjacent to the right T7 rib measuring 9 x 18 mm. Another lesion measuring 9 x 8 mm is located adjacent to the T9-10 disc space. There is a pleural-based lesion present measuring 12 x 25 mm axial dimensions located at the T10 vertebral level..The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots. No abnormal enhancing lesions are appreciated in the thoracic spine.Lumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. There are contrast enhancing foci present at L4. There is T1 signal hyperintensity throughout the L1 and L2 vertebrae. This is suspected represent radiation effect. There are marrow replacing lesions present within the iliac bones and sacrum.An enhancing lesion is present in the left half of the sacral spinal canal measuring 41 x 12 mm sagittal dimensions. It displaces the adjacent nerve roots in the left temporal canal of the sacral spine. This includes the nerve roots that exit within the left S2 and S3 neural foramen.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is no significant compromise to spinal canal or neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.There is a left presacral lesion present measuring 27 x 20 mm axial dimensions.
1.There are multiple paraspinous lesions present throughout the thoracic spine some which are adjacent to the pleura and some which are detailed above. Some are between vertebral bodies and pleural while others are adjacent to the upper spinous processes and superficial laminae. These are compatible with the recurrence of the patient's known neoplastic process of neuroblastoma.2.One of the thoracic spine lesions extends into the spinal canal through the left T4-5 neural foramen. It displaces this thecal sac towards the right. These are compatible with the recurrence of the patient's known neoplastic process of neuroblastoma.3.There is a lesion within the sacral spinal canal which displaces the left-sided S2 and S3 nerve roots. This is compatible with the recurrence of the patient's known neoplastic process of neuroblastoma.4.There are some enhancing lesions within the cervical and thoracic and lumbar spine which are suspicious for metastatic disease. Additionally there are are multiple foci of marrow replacement throughout the spine and visualized iliac bones which are also suspicious for metastatic disease. 5.There is a left presacral lesion present measuring 27 x 20 mm axial dimensions. This is also suspicious for neoplasm.6.There are mild compression fractures present at T10 and T6 which could be pathologic.