43 years Female (DOB: 2/11/1973)Reason: Hx of DLBCL, assess for lumbar lesions History: as abovePROVIDER NAME: JUSTIN P KLINE CARA ANN ROSENBAUM MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal enhancing lesions are identified in the cervical spine.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.Thoracic spine:The thoracic vertebral bodies are appropriate in the overall alignment and height. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots. There are heterogeneous ill-defined lesions present at T6 and T7 associated with some peripheral enhancement. On at T6 is approximately 10 mm and the one at T7 approximately 12 mm in size. One at the left posterior lateral aspect of T1 measures 7 mm. One at the right posterior lateral aspect of T5 measures 8 mm.Findings raise the question of hilar adenopathy. Lymph nodes are identified within the mediastinum.Lumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. There is disc desiccation present at L4-5 and L5-S1.There is a heterogeneously enhancing lesion present at L1 measuring approximately 16 x 13 mm in sagittal dimensions. It is bright on T2 and does not suppress on inversion recovery.There is an enhancing intrathecal lesion present at the right lateral recess at L2-3 which involves the nerve roots. It measures approximately 10 x 6 mm in axial dimensions and is associated with some enhancement of the involved nerve roots.Some patchy foci of enhancement are present in the sacrum and iliac bones associated with patchy marrow replacement. This involves the left sacral alla predominantly and to a lesser degree the adjacent iliac bones.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is a small right paramedian disc protrusion present at this level which mildly impresses on the nerve root at the right lateral recess but does not efface the fat surrounding it.At L4-5 there is no significant compromise to spinal canal or neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.
1.There is a leptomeningeal-based lesion present within the lumbar spinal canal at the right lateral recess at L2-3 which is associated with enhancement of the adjacent nerve roots. This is suspicious for leptomeningeal involvement of disease. In this case lymphoma could potentially be a cause.2.There are multiple patchy lesions present in the thoracic and lumbar spine at T1, T5, T6, T7, L1 as well as some patchy lesions in the sacrum. The underlying cause is unclear. The possibility that this is related to lymphoma is suggested.3.There are findings suggestive of hilar lymphadenopathy as well as mediastinal lymphadenopathy as clinically appropriate a CT of the chest may help further assess this.