Female, 55 years old, history of grade 2 astrocytoma of the spinal cord status post proton therapy one month ago plus temozolomide. Evidence of laminectomy is seen at C5 and C6 with fluid present in the laminectomy bed extending up to the dural. No evidence of dural discontinuity is seen.Expansile nonenhancing mass is redemonstrated within the cervical spinal cord. This lesion spans from C3-4 to the inferior endplate of C7 and has perhaps expanded in the craniocaudal dimension by 1 or 2 mm. In the transverse dimension, this lesion occupies a majority of the right and central aspects of the cord, measuring up to 14 x 10 mm at the C5-6 level, not significantly changed from prior. The expansile nature of this lesion results in effacement of the CSF space from C4 through C6.Expansile nonenhancing mass is also redemonstrated within the thoracic spinal cord. This lesion spans from the T2-3 level down to approximately T8. No definite evidence of any further progression in the craniocaudal extent is seen. Accurate measurements are difficult due to the presence of motion artifact, but no significant change in the transverse dimensions of this mass are suspected. For example, at the T4 level, the tumor measures approximately 10 x 9 mm, and previously measured 11 x 9 mm. Minimal nonexpansile cord signal abnormality extending inferiorly within the left lateral cord from the T8 level down to T10 is less well appreciated than on the prior examination.Mild reversal of the cervical lordosisis seen. Degenerative endplate irregularity is evident at the mid to lower cervical levels. Mild cervical spondylosis at C4-5 and C5-6 and C6-7 is unchanged.At L4-5, grade 1 anterolisthesis with disc bulging and disc uncovering is seen. Along with marked facet arthoropathy with effusions and ligamentum flavum thickening, these findings contribute to a severe spinal canal stenosis with crowding and impingement of the cauda equina nerve roots. A blush of enhancement within the nerve roots at this level likely represents compression related vascular engorgement. The neural foramina do remain patent. These findings have not significantly changed.No other areas of significant spinal canal or neuroforaminal stenosis are seen at any point in the spine. Vertebral body morphology, except as discussed above, is unremarkable. Fatty marrow replacement involving the entirety of the cervical vertebral bodies and the posterior aspects of the thoracic and upper lumbar vertebral bodies, is compatible with radiation therapy.
Multifocal spinal cord tumor is redemonstrated. The lesion in the cervical cord shows no significant change in maximal transverse dimension, and perhaps a very slight increase in craniocaudal extent. The magnitude of this potential increase is, however, on the order of 1 or 2 mm and may be technical. The lesion in the thoracic cord shows no significant interval change in maximal transverse dimension or craniocaudal extent, allowing for motion artifact.