Neoplasm of unspecified behavior of bone, soft tissue, and skin [D49.2] / Neoplasm of uncertain behavior of brain, unspecified [D43.2], Reason for Study: ^Reason: hx meningioma. Eval for change. Yearly follow up History: surveillance imaging Brain MRIRedemonstration of the right frontal operculum area extra axial enhancing lesion likely represent meningioma, no change in size, configuration and MR characteristics since prior scan. There is no evidence of other abnormal enhancement on the scan.There is no evidence of acute ischemic or hemorrhagic lesion either.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear. Right maxillary sinus retention cyst.Lumbar spine MRIFor the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. There are multifocal enhancing lesions especially around endplate. Enhancing lesions were seen on T11, T12, L1, L2, L3, L5 and S1 endplates were previously seen but the configuration has been changed. In particular, previously the enhancing pattern was diffuse enhancement but today's exam shows more confined with surrounding low signal intensity rim indicating sclerotic margin. There are, however, new enhancement on L4 inferior endplate which shows relatively diffuse enhancement as if shown on other level on previous scan. Thus, this new enhancement might be the same nature of other levels.There is no definitive evidence of metastatic lesion on this scan.At the level of L1-L2, there is about 4.7mm x7mm sized enhancing lesion indicating a small nerve sheath tumor, no change since prior scan. The spine alignment is anatomic. The vertebral body height is preserved. The signal of the visualized cord is normal. The conus medullaris terminates at theL1 level.Degenerative changes are specified by the intervertebral level as follows: L1-L2: Schmorl's node seen, no change since prior scan. No neuroforaminal narrowing or spinal stenosis. L2-L3: diffuse bulging of disc, mild to moderate left side neuroforaminal narrowing. No change since prior scan. L3-L4: broad based disc bulge with mild facet hypertrophy and ligamentum flavum hypertrophy resulting minimal to mild spinal canal stenosis, no change since prior scan. L4-L5: broad based disc bulge, facet hypertrophy and bilateral ligamentum flavum thickening indicating mild spinal canal stenosis. There is mild right side neuroforaminal narrowing. L5-S1: diffuse broad based disc bulge slightly eccentric toward right side results mild right side lateral recess narrowing.
1. No evidence of metastatic lesion on either brain MRI or Lumbar spine MRI2. Stable right frontal operculum area meningioma since prior scan.3. Interval change of previously seen multifocal vertebral endplates' diffuse enhancement into more confined with surrounding sclerotic rim indicating formation of Schmorl's nodes.4. New enhancement on the L4 vertebral body shows similar MR characteristics which was shown on other levels, thus indicating development of Schmorl's node.5. No change of L1-L2 level nerve sheath tumor since prior scan.6. Multi-level various degree degenerative changes as described above, no significant interval change since prior scan.