Clinical question: Evaluate for CSF dissemination of grade 3 PXA. Signs and symptoms: Supratentorial anaplastic PXA. Pre- and post enhanced total spine MRI:Evaluation of the cervical spine demonstrate normal signal intensity and alignment of vertebral column without detectable degenerative changes, spinal stenosis or neural foraminal compromise and no detectable abnormal enhancement. There is normal signal intensity and caliber of the cervical cord and without abnormal enhancement of the cord or the leptomeninges.Evaluation of thoracic spine demonstrate unremarkable signal intensity of the vertebral column with normal anatomical alignment and without detectable abnormal enhancement. There is also normal signal intensity and caliber of thoracic cord and without detectable cord or leptomeningeal enhancement.There is a tiny left paramedian disc protrusion at T3-T4 (axial T2 series 17 image 17) resulting in minimal flattening deformity of the cord without spinal stenosis or neural foraminal compromise.There is a small right median disc protrusion at T4-T5 (axial T2 series 17 image 24) which resulting indentation of the ventral aspect of the cord however without spinal stenosis or neural foraminal compromise.There is a small broad-based left paramedian disc protrusion at T8-T9 (axial T2 series 17 image 36) with subtle flattening of the ventral aspect of the cord without spinal stenosis or neural foraminal compromise.Evaluation of the lumbosacral spine demonstrate no abnormal enhancement of the conus or the cauda equina.There is no spinal stenosis or neural foraminal compromise at any level.Mild degenerative disc disease and mild bilateral facet and ligamentum flavum hypertrophy at L4-L5 is noted. There is a left lateral mild bulge and an annular fissure with expected enhancement present at this level.Moderate disc disease and loss of disc height and mild facet and ligamentum flavum hypertrophy at L5-S1 level is noted.
1.Pre- and post enhanced total spine MRI demonstrate no evidence of metastatic disease.2.No evidence of spinal canal or neural foraminal compromise at any level.3.Small disc protrusions with subtle associated cord flattening deformity are present at T3-T4, T4-T5 and T8-T9 levels as detailed above.4.Mild degenerative changes of the lower lumbar spine as detailed.