Female, 69 years old, with spinal cord cavernoma, with neck pain and right leg weakness, evaluate cord cavernoma and for brain CCM's. Brain:No diffusion restricting lesions are seen. Scattered small foci of white matter T2 hyperintensity are redemonstrated appearing similar in size and number to the prior examination. No evidence of edema or mass effect is seen. No pathologic parenchymal or extra-axial enhancement is seen. There are no susceptibility inducing lesions. The ventricles are normal in size and morphology. No intracranial hemorrhage or any abnormal extra-axial fluid collections are seen.Thoracic spine:A 4 mm lesion is redemonstrated within the right aspect of the spinal cord at the T4 level showing a rim of susceptibility effect and internal T2 intensity. The lesion itself has not significantly changed in size, though susceptibility effect extending above and below the lesion seems to have increased mildly. An associated 2 mm focus of enhancement is seen for which there is no adequate comparison as the prior examination was performed without contrast. No additional or new spinal cord lesions are seen.Spinal alignment is anatomic. Vertebral body heights are preserved. Multiple scattered Schmorl's nodes are seen. Ill-defined T2 hyperintense signal and enhancement are seen along the T7-8 endplates, slightly progressed from prior. Additional more well-defined foci of T2 hyperintensity and enhancement are demonstrated within the right transverse process of T5, the right posterior T8 vertebral body, the T10 and T12 vertebral bodies, without significant change. Mild disc degeneration is seen but without any large herniation, spinal canal or foraminal stenosis.
1.A subcentimeter lesion is redemonstrated within the right lateral aspect of the spinal cord at the T4 level showing peripheral hemosiderin staining and a small focus of associated enhancement. The imaging features of the lesion remain most suggestive of a cavernous malformation. Peripheral hemosiderin staining seems to have progressed from prior which may indicate slow interval bleeding.2.Scattered areas of marrow signal abnormality and enhancement are redemonstrated. Some of these are centered on the endplates in association with Schmorl's node deformities, as at T7-8 where findings have mildly progressed from prior. Also noted are scattered more well-defined marrow lesions which have not significantly changed. These findings are favored to represent a combination of degenerative change and atypical hemangiomas. However, the possibility of a neoplastic process cannot be entirely excluded. If clinically warranted, assessment of osseous integrity by CT may allow a more definitive diagnosis.3.No evidence of any intracranial cavernous malformation or other acute intracranial findings.