 Brain MRI:There are numerous contrast enhancing masses throughout the supratentorial and infratentorial brain. The largest supratentorial lesion is within the right frontal lobe measuring 2.2 x 1.9 cm in transaxial dimension. The largest infratentorial lesion measures 2.3 x 2.2 cm and is located in the anteromedial right cerebellum. The larger lesions demonstrate irregular peripheral enhancement with an MRI appearance of central necrosis. Several also demonstrate susceptibility-weighted abnormality representing central hemorrhagic products. Larger lesions have associated vasogenic edema, although none have significant associated mass effect. Additionally, there is a background of diffuse T2 hyperintensity throughout the supratentorial white matter which suggests changes from prior therapy.The ventricles and sulci remain normal in size. The cerebellar tonsils are in normal position. There is no midline shift. The pituitary gland is normal in size. There is no evidence for acute intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. A small mucous retention cyst versus polyp is noted in the left maxillary sinus. Fluid is present within bilateral mastoid air cells.Cervical MRI:There is an expansile, irregularly enhancing, necrotic appearing lesion involving the cervical cord spanning the levels from C3 through C6, measuring up to 5.3 cm in length. There is associated edematous changes extending superiorly and inferiorly, from the level of the cervicomedullary junction to T3. Increased fat signal within the adjacent vertebral bodies suggests prior radiation therapy. Enhancement within the interspinous tissues between C3 and C5 suggest there may have been prior biopsy.There is slight reversal of upper cervical curvature. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable. Fluid is present within the nasal pharynx, oropharynx, and hypopharynx around the patient's intubation tube. A small T2 hyperintense focus is noted within the right thyroid lobe. Mild degenerative changes are noted throughout without significant stenosis.Lumbar MRI:Alignment is anatomic. There are no fractures or subluxations. The marrow signal is benign. The conus is normal in signal and morphology and terminates at an appropriate level. The partially imaged gallbladder appears distended. There are mild degenerative changes without significant stenosis.
1.There are numerous contrast enhancing masses throughout the supratentorial and infratentorial brain. The largest supratentorial lesion is within the right frontal lobe measuring 2.2 x 1.9 cm in transaxial dimension. The largest infratentorial lesion measures 2.3 x 2.2 cm and is located in the anteromedial right cerebellum. The larger lesions demonstrate irregular peripheral enhancement with an MRI appearance of central necrosis. Several also demonstrate susceptibility-weighted abnormality representing central hemorrhagic products. Larger lesions have associated vasogenic edema, although none have significant associated mass effect. Additionally, there is a background of diffuse T2 hyperintensity throughout the supratentorial white matter which suggests changes from prior therapy.2.There is an expansile, irregularly enhancing, necrotic appearing lesion involving the cervical cord spanning the levels from C3 through C6, measuring up to 5.3 cm in length. There is associated edematous changes extending superiorly and inferiorly, from the level of the cervicomedullary junction to T3. Increased fat signal within the adjacent vertebral bodies suggests prior radiation therapy. Enhancement within the interspinous tissues between C3 and C5 suggest there may have been prior biopsy.3.No abnormal enhancement within the lumbar spine. The partially imaged gallbladder appears distended (please see abdominal CT dictation from 10/30/2015 for complete characterization).