Male, 29 years old, history of neurofibromatosis type I with plexiform neurofibroma of the spinal cord, presenting with back pain and headaches. Assess for any change in plexiform tumor and any nerve root enhancement. Cervical:Mild prominence of a number of the spinal nerve roots is again seen in the cervical region appearing similar to prior exam. Nerve root enhancement is most conspicuous at C3-4 and C4-5 bilaterally.No pathologic spinal cord signal is seen. No intraspinal mass is detected. Incidental note is made of a round T2 hyperintense lesion within the left cerebellar hemisphere which is stable and likely reflective of a FASI of neurofibromatosis.Spinal alignment is anatomic. Vertebral body morphology is within normal limits. No worrisome marrow abnormalities are detected. No disc disease, spinal canal stenosis or neuroforaminal narrowing is detected.Scattered small nodules are evident within the paraspinal and superficial soft tissues.Thoracic:In the thoracic region, only the left T7-8 foraminal nerve root appears to be convincingly thickened and this finding is unchanged. There is questionable mild bilateral nerve root thickening at lower thoracic levels.Postcontrast images are somewhat degraded by motion, but no additional mass lesions are suspected.The visualized spinal cord demonstrates normal signal intensity and morphology. No intraspinal masses are seen.Spinal alignment is anatomic allowing for mild scoliotic curvature. No concerning marrow abnormalities are seen. No significant disc disease, spinal canal stenosis or neuroforaminal narrowing is detected.Scattered small nodules are evident within the paraspinal and superficial soft tissues.Lumbar:The cauda equina appears to be peppered with numerous very small nodules (no more than 2 to 3 mm in size, best seen on sagittal images) which are unchanged from the prior exam.An enhancing intraspinal mass is again demonstrated centered at the L5/S1 level. This lesion measures 31 mm CC x 27 mm TV x 20 mm AP and is unchanged in size. The lesion fills the spinal canal and even scallops into the S1 and S2 vertebral bodies. The lesion extends in plexiform fashion along the sacral spinal nerve roots into the sacral foramina.Bilateral thickening of the foraminal nerve roots is seen most conspicuously at lower lumbar levels, a finding which is unchanged. Nerve root thickening continues extra foraminally along the neurovascular bundles as well.Spinal alignment is anatomic. Vertebral body morphology is unremarkable. No worrisome marrow abnormalities are detected. No significant degenerative disc disease, spinal canal stenosis or neuroforaminal narrowing is detected.
1.Plexiform disease of the lower lumbar and sacral nerve roots is redemonstrated appearing similar to the prior examination. This includes a large canal filling mass centered at the L5-S1 level with foraminal and extraforaminal extension.2.A peppering of small nodules is also suspected along the cauda equina more superiorly, and this is unchanged.3.In the thoracic region, only the left T7-8 nerve root shows convincing evidence of tumoral thickening and this is unchanged.4.In the cervical region, bilateral nerve root thickening is evident at several levels appearing similar to the prior exam.5.No evidence of any definite new intraspinal, foraminal or paraspinal mass is detected.