 MRI brain:Redemonstrated are diffuse small foci of susceptibility throughout the brain, likely representing post radiation changes. There has been interval appearance of a T2/FLAIR and T1 hyperintense lesion in the left paracentral parietal region which demonstrates prominent susceptibility and measures 13 x 17 mm (series 4, image 9) indicating a focal area of blood products. There is no significant surrounding FLAIR signal abnormality or hemosiderin rim and there is associated diffusion restriction from the blood products. There is a background of scattered foci of susceptibility abnormality. Note however that a focus of susceptibility was not definitively located in the location of the above described lesion on the prior MRI exam.The ventricles and sulci are within normal limits. The cisterns remain patent. There is no midline shift or mass effect. A few nonspecific scattered punctate foci of FLAIR hyperintensity are again seen. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. MRI spine:Diffuse postradiation marrow changes are again noted. A 12 mm STIR hyperintense enhancing lesion in the posterior-superior aspect of C7 vertebral body is unchanged. There is a stable region of irregular marrow enhancement and STIR hyperintensity in the left posterior T6 vertebral body minimally extending into the left pedicle, again appearing similar to prior.Previous tiny foci of nodular enhancement along the ventral medulla on the left at the level of the clivus tip is not well seen on today's exam. The left ventral C1 level enhancing punctate lesion along the surface of the cord is stable. Scattered punctate foci of enhancement along the dorsal and lateral surface of the distal thoracic cord appear overall decreased in conspicuity. There is also slight decreased irregular enhancement along the surface of the conus. No abnormal cord signal is seen. Redemonstrated is a stable punctate focus of enhancement along the right ventral cauda equina at L1-L2. A small rounded enhancing lesion along the left cauda equina at the L2 level measuring 7 x 4 mm is also stable. There has been significant interval decrease in the plaque-like enhancement along the distal thecal sac. There is also decrease in the diffuse enhancement of the cauda equina nerve roots and CSF is now visualized in between the nerve roots.Postoperative changes relating to lower lumbar laminectomies are redemonstrated. Mid thoracic and mid lumbar spondylotic changes appear similar. There remains moderate-severe central spinal canal stenosis at L3-L4.
MRI brain:On a background of previously noted innumerable punctate foci of susceptibility throughout the brain, interval development of a larger left T2/FLAIR and T1 hyperintense lesion in the left paracentral parietal region which demonstrates avid susceptibility abnormality indicating a focal area of blood products. There is no significant surrounding FLAIR signal abnormality to suggest significant vasogenic edema. Given history of prior radiation treatment, these findings may represent an underlying postradiation cavernoma that has bled versus some other hemorrhagic lesion with the possibility of metastases not entirely excluded. Note however that a focus of susceptibility was not definitively located in this region on the prior exam.MRI Spine:1.Overall, stable appearance of the upper spine with improvement of the multiple regions of enhancement in the lower thecal sac.2.Stable postsurgical changes in the lower lumbar spine with persistent moderate-severe central spinal canal stenosis at L3-L4.