Clinical question: Multiple sclerosis; follow-up progression. Signs and symptoms: Paresthesia. Nonenhanced MRI:Precise comparison is difficult due to significant differences in technique between the current standard brain MRI 4 mm slices compared to prior dedicated MS protocol with 2 mm slices.Examination is severely limited due to poor quality images related to technical issue with the equipment. Patient was moved to a different scanner however repeat images of brain MRI were not obtained due to patient's concern of missing her clinic appointment.Within this severe limitation of the exam there is suggestion of progression of demyelinating disease. There is a new right frontal periventricular white matter lesion best appreciated on axial FLAIR series 11 image 11 and sagittal FLAIR series 4 image 17. There is a new left mid temporal periventricular white matter lesion on axial FLAIR series 11 image 20 and sagittal FLAIR series 4 image 7. Interval new right periventricular white matter lesion in the right posterior temporal best appreciated on axial FLAIR series 11 image 15. Images through posterior fossa are suboptimal and the lesions from prior exam are not identified and no convincing evidence of new lesion.Nonenhanced cervical MRI:Examination was performed utilizing a different MRI scanner. Images on sagittal T2 and STIR are severely degraded due to motion artifact.Similar to prior study there are diffuse foci of T2 hyperintensity throughout the cervical cord without convincing evidence of any significant change. Degenerative changes at C5-C6 is again noted. There is a central disc protrusion with slight bulge into the spinal canal and subtle flattening deformity of the cord and mild central spinal stenosis. There is interval progression of degenerative changes.There is a visualization of a tiny left paramedian annular fissure at C6-C7 level similar to prior exam.Nonenhanced thoracic MRI:There is diffuse confluent T2/T2 STIR hyperintensity throughout the thoracic cord with uniformly smaller than expected caliber of the cord and consistent with patient's diagnosis of demyelinating disease. There is no convincing evidence of interval change since prior exam.The signal intensity in the alignment of vertebral column remains within normal. There is no evidence of spinal stenosis.
1.Nonenhanced brain MRI is severely compromised due to technical issue with the equipment. Within this limitation there is suggestion of interval progression of disease with multiple new supratentorial lesions as detailed above.2.Suboptimal nonenhanced MRI of cervical spine redemonstrate diffuse patchy T2 hyperintensity of the cervical cord consistent with demyelinating disease without convincing evidence of change since prior exam. Degenerative changes at C5/C6 is again noted with evidence of a small central disc protrusion contributing to mild central spinal stenosis.3.Nonenhanced MRI of thoracic spine demonstrate extensive confluent foci of T2/T2 STIR hyperintensity involving nearly the entire cord and without convincing detectable interval change since prior study. Mild degenerative changes of thoracic spine however without spinal stenosis or neural foraminal compromise.