Clinical question: Evaluate for spinal lesion. Signs and symptoms: History of T1 lesion with worsening. Pre-and post-enhanced cervical MRI:Examination redemonstrates a intramedullary mass extending from lower C7 to lower T2 level similar to prior exam. This finding remains similar in size and extent to prior study demonstrate no surrounding edema. There is however faint T2 hyperintensity within the cord immediately superior to the tumor suggestive of hemosiderin deposition. The main bulk of tumor and measures approximately 22.8 mm in cranial cephalad and 8.6-mm in AP axis similar to prior study. The less defined inferior extension of tumor has mixed signal intensity and extend for approximately 20 mm further inferiorly and terminates at lower T2 level. There is no convincing evidence of enhancement however T1 hyperintensity signal of tumor can obscure enhancement. There is no evidence of cord edema. The finding is suggestive of a cavernoma however previously detailed multiple differential diagnosis of a spontaneous cord hemorrhage or hemorrhagic infarct cannot be entirely excluded however are considered less likely. This mass centrally located disk protrusion at C6 -- C7 demonstrates subtle interval increased size since prior exam. This finding results in very subtle indentation of ventral aspect of the cord and mild central spinal stenosis.Pre--and post enhanced thoracic MRI:Examination demonstrate normal signal intensity and caliber of thoracic cord inferior to the above detailed tumor. There is also no detectable abnormal enhancement of the cord or the leptomeninges.The signal intensity of vertebral column demonstrate changes related to degenerative disease and unremarkable otherwise.T5 -- T6 there is a central and right paramedian disk protrusion with resultant effacement of ventral subarachnoid space, slight flattening and posterior displacement of the cord however without convincing evidence of central spinal stenosis or neural foraminal compromise.A tiny left lateral disk protrusion at T6 the T7 is best appreciated on axial T2 series 1401 on image 33. No spinal stenosis or neural foraminal compromise.The small right paramedian hypertrophic spur at T7 -- T8 is noted without spinal stenosis or neural foraminal compromise.A tiny central disk protrusion at T8 -- T9 is noted. Hypertrophic changes of posterior elements at T9 -- T10 is also in moderate neural foraminal compromise on the right. Unremarkable images at other levels.Pre-and post enhanced lumbar MRI:Examination post right normal signal intensity and morphology the conus and the cauda equina with out detectable abnormal enhancement.The alignment of vertebral column is anatomical.T12 -- L1 demonstrate moderate disk disease and loss of disk height and unremarkable otherwise.L1 -- L2, L2 -- L3, L3 -- 4 levels are negative for spinal canal compromise or neural foraminal stenosis.L4 -- L5 demonstrate moderate disk disease and loss of disk height, broad based central and leftward disk protrusion without central spinal stenosis or neural foraminal compromise mild left lateral recess compromise however is present. Mild bilateral facet hypertrophy changes at this level also present.L5 -- S1 demonstrate moderate disk disease with loss of disk height and mild hypertrophic changes of posterior elements (left greater than right). There is a central and leftward shallow broad-based disk protrusion without central spinal stenosis or neural foraminal compromise. This finding however is in contact with the left S1 nerve root in the left lateral recess of the canal.
1.Pre-and post enhanced MRI of cervical spine demonstrate a stable intramedullary tumor extending from lower C7 to lower T2 level. The mass has a well demarcated superior component and an ill-defined component further inferiorly. Combination of two segments measures at 43-mm in cranial cephalad axis and a more well defined measures at 22.8-mm. There is suggestion of hemosiderin deposition superior to the tumor. Findings are more suggestive of a known cavernoma as detailed above. Other less likely differential diagnosis of a spontaneous cord hemorrhage or hemorrhagic infarct cannot be entirely excluded. New since prior exam is slight increase size of this protrusion at C6 -- C7 with result in mild central spinal stenosis.2.Pre-and post enhanced MRI of thoracic spine view demonstrates above detailed information any mass. The signal intensity and caliber of the cord otherwise is unremarkable and without abnormal enhancement. Disk protrusion at T5 -- T6 with subtle mass effect on the cord and without central spinal stenosis is noted. Additional small disk protrusions and hypertrophic spurs as detailed above. No central spinal stenosis at any level.3.Pre-and post enhanced MRI of one or spine demonstrate degenerative changes including disk protrusion at L4 -- L5 and L5 -- S1 levels without central spinal stenosis or neural foraminal compromise. Please see above comments. 