65-year-old female with history of NSCLC with leptomeningeal carcinomatosis. Receiving IT chemo. MRI BRAIN: When compared to the prior MRI brain study dated 10/1/2015 there is been interval placement of a right frontal approach Ommaya catheter with tip terminating within the left lateral ventricle near the foramen of Monro. There is T2/FLAIR hyperintensity surrounding the course of the catheter which may represent edema or gliosis. Small amount of pneumocephalus. There is abnormal layering diffusion signal within the occipital horns of the lateral ventricles which may be related to blood products or other material.No abnormal parenchymal or leptomeningeal enhancement. No intracranial mass or mass effect. No midline shift or herniation. The paranasal sinuses and mastoid air cells are clear. The orbits are unremarkable.MRI COMPLETE SPINE: Cervical spine:Alignment is maintained with no acute fractures or subluxation. No abnormal marrow signal or enhancement is noted. The craniocervical junction is maintained. The ligamentous structures are intact. The cervical spinal cord is normal in signal without abnormal enhancement. C2/3 demonstrates no significant spinal canal or neural foraminal stenosis. C3/4 demonstrates left uncinate and facet hypertrophy with associated moderate left neural foraminal stenosis. No significant right neural foraminal or spinal canal stenosis. C4/5 demonstrates left facet hypertrophy causes mild left neural foraminal stenosis. No significant right neural foraminal or spinal canal stenosis. C5/6 demonstrates severe left facet hypertrophy. There is mild-to-moderate left neural foraminal stenosis. No significant right neural foraminal or spinal canal stenosis. C6/7 demonstrates mild bulging of the disc, bilateral uncinate and facet hypertrophy. There is mild to moderate neural foraminal stenosis bilaterally. No significant spinal canal stenosis. C7/T1 demonstrates bilateral facet hypertrophy associated with mild bilateral neural foraminal stenosis. No significant spinal canal stenosis. Thoracic spine: T1 shortening in the T9-T12 bodies suggests prior radiation therapy. No abnormal marrow signal or enhancement is noted elsewhere. T1/2 demonstrates no significant disc bulge or cord encroachment.T2/3 demonstrates no significant disc bulge or cord encroachment. T3/4 demonstrates no significant disc bulge or cord encroachment. T4/5 demonstrates a tiny midline disc protrusion causing slight flattening of the anterior cord surface without intrinsic cord signal abnormality. T5/6 demonstrates a small midline disc protrusion causing slight flattening of the anterior cord surface without intrinsic cord signal abnormality.T6/7 demonstrates a tiny right paramedian disc protrusion without cord encroachment. T7/8 demonstrates no significant disc bulge or cord encroachment. T8/9 demonstrates a large central disc extrusion extending above the disc level causing anterior cord flattening without intrinsic cord signal abnormality. T9/10 demonstrates a large central disc extrusion extending above the disc level causinganterior cord flattening without intrinsic cord signal abnormality.T10/11 demonstrates a small left paracentral disc protrusion without cord encroachment. There is moderate to severe narrowing of the right neural foramen with enhancing tissue noted on the current and prior study. Finding may be related to scarring but recommend attention on follow-up. T11/12 demonstrates no significant disc bulge or cord encroachment. T12/L1 demonstrates no significant disc bulge or cord encroachment. Lumbar spine:Significant artifact limits evaluation on the postcontrast sequences of the lumbar spine however there appears to be improvement in the extent of nodular enhancement of the leptomeninges on the surface of the conus and cauda equina nerve roots. There does remain abnormal leptomeningeal enhancement which is better assessed on the sagittal sequences, however the nodularity appears improved.Alignment is anatomic. There are no fractures or subluxations. No abnormal marrow signal or enhancement is identified.L1/L2 demonstrates mild facet hypertrophy with no significant neural foraminal or spinal canal stenosis.L2/3 demonstrates mild bulging of the disc no significant neural foraminal or spinal canal stenosis. L3/4 demonstrates mild disc bulge and mild bilateral facet hypertrophy without significant neural foraminal or spinal canal stenosis. L4/5 demonstrates Diffuse annular disc bulge, ligamentum flavum thickening, severe left facet hypertrophy, moderate right facet hypertrophy, and a tiny left facet effusion. There is mild to moderate neural foraminal stenosis on the left and mild neural foraminal stenosis on the right. L5/S1 demonstrates mild bulging of the disc, ligamentum flavum thickening and facet hypertrophy with no significant neural foraminal or spinal canal stenosis. There is partial sacralization of L5.
1. No evidence of intracranial metastatic disease. Since the prior MRI brain study dated 10/1/2015 there has been interval placement of a right frontal approach Ommaya catheter. There is T2/FLAIR hyperintensity along the catheter tract which may represent edema or gliosis. No associated mass effect. There is small amount of pneumocephalus as well as abnormal layering diffusion signal related to dependent debris/blood products within the occipital horns of the lateral ventricles. These findings may be related to recent catheter manipulation/injection.2. There has been interval improvement in the extent of nodular enhancement of the leptomeninges on the surface of the conus and cauda equina nerve roots. 3. There is enhancing tissue filling the right T10-T11 neural foramen which is similar to prior. Finding may possibly be related to scarring but recommend attention on follow-up.