14 year old male with osteoblastoma status post resection in January 2013 presenting for pre-operative planning. This exam is markedly limited by artifact from the patient's dental braces as well as by patient motion. The diffusion sequence is non-diagnostic and the fat saturation is markedly degraded by susceptibility limiting this study.There is again a large expansile mass arising from the left aspect of the C3 vertebral body, involving the left pedicle and transverse process. There is extension cranially to involve C2 and caudally to involve C4. Central lower signal correlates with areas of dense calcification. The well-defined portion of the mass is grossly unchanged in size compared with the recent CT, measuring up to 42 x 44 mm (series 901 image 23). Overall, the mass is much larger than the original tumor.There is prominent associated infiltrative pattern T2 hyperintensity and enhancement within the adjacent soft tissues following tissue and muscular planes, including the prevertebral space with extension to the right side at the C2-C5 levels. There is extension into the widened left C2-C3 and C3-C4 foramen, as well as asymmetric abnormal signal and enhancement suggested along the left C4-C5, and C5-C6 foramina. There is anterior displacement of the left cervical vessels, greatest at the level of the carotid bifurcation with associated likely reactive changes. The left C3-C4 neural foramen extension results in near complete effacement of CSF space at this level and overall moderate spinal canal stenosis. There is no definite cord signal abnormality. Evaluation at these levels is markedly limited by artifact from the patient's braces.There is absent flow within the left vertebral artery compatible with prior embolization. The other flow voids are present. There is also a dilated collateral vessel arising inferiorly and coursing along the lateral aspect of the mass, possibly supplying the mass but not well evaluated on this exam. Another tortuous collateral vessel is seen along the inferomedial aspect of the mass. There are grossly unchanged nonspecific bilateral cervical lymph nodes that are not significantly enlarged. There is ill-defined abnormal signal intensity within the C2-C5 vertebrae.The thyroid and parotid glands are unremarkable. Submandibular glands are not well assessed on this exam. The airways are patent. The imaged intracranial structures are unremarkable. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved.
1.Markedly limited exam secondary to patient's dental braces and motion artifact, specifically at the level of the lesion.2.Large expansile mass with central calcification arising from the left aspect of the C3 vertebral body is grossly unchanged compared with the recent CT, and much larger than the original mass. This would be compatible with recurrent osteoblastoma, perhaps of the more aggressive type.3.Extensive signal abnormality and enhancement involving the C2-C5 vertebrae and paravertebral soft tissues likely represents associated "flare phenomenon" rather than tumor.4.There is complete effacement of the CSF space at the C3-C4 level secondary to left foraminal extension of tumor but no definite cord signal abnormality at this time.