 MRA HEAD: There is a rounded focus of signal loss in the location of the previously described distal right ICA aneurysm, which is consistent with the known coil mass. There is a linear area of flow related enhancement just medial to the coil mass, which is favored to represent a previously seen tiny vein. There is no definite flow-related enhancement within the coil mass itself. There is slightly decreased flow related enhancement within the cavernous portion of the right internal carotid artery, which is likely related to previous stent placement upon angiographic image review.The left internal carotid and bilateral middle and anterior cerebral arteries are unremarkable. The vertebral arteries, basilar artery, and posterior cerebral arteries are normal in course and caliber. There is no evidence of aneurysm. There is an area of encephalomalacia in the left frontal lobe, which corresponds to the patient's evolved prior hematoma. Lumbar Spine: The spinal cord terminates abnormally low, with the conus medullaris located just above the level of the inferior endplate of the L3 vertebral body. There is no evidence of a fatty filum terminale. There is no cord signal abnormality. For the purposes of numbering, there are 5 lumbar-type vertebral bodies. The vertebral body and intervertebral disc space heights are well-preserved. There is a diffusely heterogeneous appearance of the bone marrow with overall low signal, which is nonspecific but may be the result of sclerosis. There are multilevel degenerative changes as detailed below. T11-T12: There is thickening of the ligamentum flavum with mild central spinal canal stenosis. There is no significant neuroforaminal stenosis at this level.T12-L1: There is no significant central spinal canal or neuroforaminal stenosis.L1-L2: There is no significant central spinal canal or neuroforaminal stenosis.L2-L3: There is no significant central spinal canal or neuroforaminal stenosis.L3-4: There is no significant central spinal canal stenosis. There is shallow right foraminal disc protrusion with mild right neuroforaminal stenosis. There is no significant left neuroforaminal stenosis.L4-L5: There is approximately 6 mm of anterolisthesis of L4 on L5 with uncovering of the disc at this level. There is mild central spinal canal stenosis and compression of the thecal sac. There is facet hypertrophy and mild ligamentum flavum thickening with moderate bilateral neural foraminal stenosis. L5-S1: There is facet hypertrophy with moderate to severe left neural foraminal and moderate right neuroforaminal stenosis. There is no significant central spinal canal stenosis. There are no definite osseous changes to suggest prior surgery at this level, however, the left ligamentum flavum appears somewhat attenuated which could be postoperative.A right renal and liver cysts are incidentally noted, which appear similar to the prior CT abdomen dated 7/29/2014.
1. Findings of prior coil embolization of a distal right ICA aneurysm without evidence of complication. No new aneurysms are seen. 2. Heterogeneous bone marrow with diffuse low signal is non-specific but may represent sclerosis such as due to renal osteodystrophy, or a diffuse infiltrating process. If clinically indicated, a bone scan may be obtained for further evaluation. 3. Multilevel degenerative changes of the lumbar spine, most pronounced at L4-5 and L5-S1 as detailed above. 