 BRAIN: There is mild motion artifact degrading image quality. There is no acute infarct, mass effect or midline shift. There are mild nonspecific T2 hyperintensities in the periventricular and subcortical white matter which likely represent chronic microvascular ischemic changes. This tiny focus of T2 hyperintensity with a linear configuration in the right parietal lobe with mild susceptibility which maybe related to chronic ischemic injury or possibly developmental venous anomaly which can be better assessed with postgadolinium sequence. There is mild diffuse global volume loss for patient age. There is a partial empty sella incidental noted. The flow-voids of the skull base are intact. There is a left maxillary sinus mucous retention cyst versus polyp. There is mild ethmoid sinus mucosal thickening.CERVICAL: There is mild motion degradation limiting evaluation. There is anterior fusion C5 and C6 with fusion at the disk space. There is slight interval enlargement of disk osteophyte complexes at C3-4, C4-5 and C6-7 as compared to the prior MRI from 11/7/2011. There are type I degenerative changes at the inferior endplate of C4. The alignment of the cervical spine is within normal limits. The osseous marrow signal is benign. The cervical cord signal is within normal limits. C2-3: No spinal canal or neural foraminal stenosis.C3-4: Disk osteophyte complex and ligamentum flavum thickening with mild central spinal canal stenosis. Bilateral uncovertebral hypertrophy, right greater than left with moderate right and mild left neural foraminal stenosis.C4-5: Disk osteophyte complex and bilateral uncovertebral hypertrophy with ligamentum flavum thickening causing mild to moderate central spinal canal stenosis and moderate right and mild left neural foraminal stenosis.C5-6: Disk osteophyte complex with left greater than right uncovertebral hypertrophy causing mild left neural foraminal stenosis and minimal central spinal canal stenosis. No right neural foraminal stenosis.C6-7: Disk osteophyte complex eccentric to the left with ligamentum flavum thickening causing mild central spinal canal stenosis. Bilateral uncovertebral hypertrophy with mild to moderate bilateral neural foraminal stenosis.C7-T1: Small disk osteophyte complex with no significant central spinal canal or neural foraminal stenosis.THORACIC: There is mild motion artifact limiting evaluation. Within this limitation, the cord signal and caliber are unremarkable. There is normal alignment of the thoracic spine. The vertebral body heights are preserved. There is mild disk desiccation at multiple levels in the thoracic spine. There are small superior endplate Schmorl's nodes at T3 and T5, stable from prior exam. There is minimal overall loss of vertebral body height without evidence of edema to suggest an acute compression fracture. There are minimal disk bulges at T1-T2, and T8-T9. No spinal canal or neural foraminal stenosis in the thoracic spine. Small T9 vertebral body hemangioma.Intrathecal catheter is faintly seen. No obvious granuloma formation is seen although axial thoracic images are motion degraded. Catheter appears to terminate in the lower thoracic spine.LUMBAR: The first non-rib bearing vertebral body is referred to as L1, with the last well-formed disk space being referred to as L5-S1, consistent with prior exam. There is normal alignment of the lumbar spine. The osseous marrow signal is benign. Vertebral body heights are preserved. There is desiccation with moderate loss of disk height at L4-5, and mild loss of disk height at L3-4 and L5-S1. There is mild stranding in the subcutaneous soft tissues of the back and the left upper gluteal region consistent with postsurgical changes. The conus terminates at L2, within normal limits.L1-2: No disk herniation, central spinal canal or neural foraminal stenosis.L2-3: Minimal disk bulge and facet arthropathy with no significant central spinal canal or neural foraminal stenosis.L3-4: Diffuse disk bulge, facet arthropathy encroach upon the bilateral subarticular zones without significant subarticular zone stenosis or central spinal canal stenosis. No significant neural foraminal stenosis.L4-5: Diffuse disk bulge with central disk protrusion, advanced right facet arthropathy and moderate left facet arthropathy causing no significant central spinal canal stenosis with mild right neural foraminal stenosis. No significant left neural foraminal stenosis.L5-S1: Diffuse disk bulge with central/left paracentral protrusion. No significant central spinal canal stenosis. Moderate facet arthropathy. Mild bilateral neural foraminal stenosis.There are few small right renal cysts. There is an incompletely characterized 24 x 19 mm left adrenal nodule, grossly stable from prior exam dated 1/3/2011.
1.No acute infarct, mass effect or midline shift.2.Mild diffuse global volume loss and mild chronic small vessel ischemic changes. Tiny linear focus of T2/flair hyperintensity in the right parietal lobe with susceptibility favored to represent a small chronic infarct with chronic microhemorrhage. Tiny developmental venous anomaly is also possible at this location and can be better assessed with postgadolinium study if clinically indcated.3.Stable postsurgical changes from anterior fusion at C5-6 with adjacent segment disease and mild enlargement of disk osteophyte complexes at C3-4, C4-5 and C6-7 compared to 11/7/2011 MRI. There is resulting mild to moderate central spinal canal stenosis and variable degrees of neural foraminal stenoses as detailed above.4.No significant disk herniation, central spinal canal or neural foraminal stenosis in the thoracic spine. Small Schmorl's nodes with mild chronic compression deformities at T3 and T5 is unchanged since 2011 without evidence of vertebral body edema. Multilevel lumbar spondylosis with significant interval change from 2011. 5.Intrathecal catheter is faintly seen. No obvious granuloma formation is seen although motion degradation slightly limits evaluation.6.Stable incompletely characterized left adrenal nodule.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.