Female, 50 years old, with history of von Hippel-Lindau with history of cerebellar and spinal hemangioblastomas. Evaluate for new lesions. Brain:Findings are seen compatible with prior suboccipital craniotomy. Mild distortion of the cervicomedullary junction may be related to the prior surgery and is unchanged.No evidence of any significant parenchymal edema or mass effect is detected in the brain or cerebellum. No reliably detectable enhancement is seen within the cerebrum or cerebellum. A few scattered punctate foci of enhancement noted in the cerebellum on the prior MRI have either resolved or are not detected due to technical differences.No significant parenchymal edema or mass effect seen. No abnormal extra-axial fluid or evidence of intracranial hemorrhage is noted. The ventricular system is within normal limits.Spine:Image quality is degraded by motion artifact. Within this limitation, the following observations are made.The posterior arch of C1 has been resected likely in combination with suboccipital craniotomy. Also noted is evidence of prior C4 and C5 laminectomy. Surgical changes appear similar to prior.A 4 mm focus of enhancement along the right posterior spinal cord at the C3-4 level, and a 5 mm focus of T2 hyperintensity and enhancement along the right posterior aspect of the cord at C4-5 both appear similar to the prior examination allowing for differences in technique.A 4 mm focus of T2 hyperintensity and enhancement along the left posterior cord at the C7-T1 level is unchanged. Likewise small foci of enhancement along the right posterior cord at T5, and two small enhancing lesions along the left posterior cord at T9 are unchanged. Mildly prominent vascularity is seen along the dorsal surface of the distal spinal cord and conus.A 2 mm focus of enhancement is evident along the proximal cauda equina at the L2 level. The prior lumbar spine MRI was performed without contrast so comparison is not accurate. No other reliably detectable intrathecal lesions are seen. Reversal of the cervical lordosis is seen with mild disc osteophyte formation at C3-4, C4-5 and C5-6. No areas of significant spinal canal or foraminal stenosis are seen in the cervical region.In the thoracic region, spinal alignment is anatomic. Vertebral body morphology is within normal limits allowing for mild concavity of the T12 superior endplate. No significant disc herniations or spinal canal or foraminal stenosis are seen.In the lumbar region, spinal alignment is anatomic and vertebral body morphology is within normal limits. Mild disc degeneration is seen at L4-5 with a small central protrusion and mild generalized disc bulging. No significant spinal canal or foraminal stenosis is seen.Multiple cystic renal lesions are noted incidentally.
1.Findings are seen compatible with suboccipital craniotomy, presumably for prior resection of a posterior fossa tumor.2.No definite evidence of any intracranial enhancing lesions are seen. Several punctate enhancing foci were present in the cerebellum on the prior outside MRI, but these are not seen on today's study which could reflect interval resolution or technical differences.3.Postoperative findings are seen compatible with C4 and C5 laminectomy, again presumably for intraspinal tumor resection.4.Multiple small foci of enhancement are noted predominantly along the dorsal surface of spinal cord involving the cervical and thoracic levels as well as the proximal cauda equina. None of these lesions shows evidence of significant interval change, and no definite new spinal lesions are noted.