Clinical question: Grade II astrocytoma of the cord. s/p RT 9w/ proton beam) + TMZ. Now receiving TMZ. Completed RT in ~5/2015. Signs and Symptoms: Grade II astrocytoma of spinal cord. Pre- and post enhanced cervical MRI:Examination redemonstrate an expansile lesion of the cervical cord extending from C2-C4 disc level to C7-T1 disc level. The expanded lesion occupies the entire spinal canal with effacement of subarachnoid space in particular at C5 level. The lesion is primarily on the right aspect of the cord however mildly extends across the midline to the left. It demonstrate T2/T2 STIR hyperintense and slightly hyperintense on T1-weighted images. The signal intensity, overall morphology and size of this mass remains identical to prior study.Mild-to-moderate degenerative changes of cervical spine most severely at C4-C5 through C6-C7 levels similar to prior exam and with evidence of mild reversal of cervical lordosis is again noted.Moderate to advanced degenerative changes of cervical spine in particular at C4-C5 through C6-C7 levels are present. There is resultant mild reversal of cervical lordosis. Signal changes of cervical vertebral column suggestive of prior radiation treatment.No detectable enhancement of the expansile cord lesion similar to prior exam.Pre and post enhanced thoracic MRI:Examination demonstrate a stable expansile lesion of the thoracic cord in signal intensity, morphology and extent since prior study. This mass extends from approximately mid T2 level inferiorly to mid T8 level similar to prior study. It measures approximately at 112 mm in craniocaudad axis. There is faint band of T2 STIR hyperintense extending from the inferior aspect of this mass to approximately the level of the conus with mild expansion of the cord similar to prior study. Finding is believed to represent peritumoral edema or possibly post radiation change.The signal intensity of vertebral column demonstrate changes consistent with prior radiation therapy. The alignment of vertebral, remains within normal.Mild to moderate degenerative disc disease and including a tiny disc protrusion at T7-T8 resulting tiny indentation of the ventral aspect of the cord.Post contrast images demonstrate no enhancement of the expansile cord lesion, which is a similar observation as prior exam.Pre- and post enhanced lumbar MRI.Signal intensity changes on vertebral column consistent with prior radiation in the upper lumbar spine is noted.There is normal anatomical alignment of vertebral column.There is moderate degenerative changes of the disc and facet hypertrophic changes and including bilateral facet effusion at L4-L5 with resultant moderate central spinal stenosis remain similar to prior exam.Post enhanced images demonstrate expected enhancement of the generative/hypertrophic changes of lower lumbar spine and without evidence of metastatic disease to the vertebral column or of the leptomeninges.
1.Stable expansile mass of the cervical cord in size, extent and overall morphology as detailed.2.Stable expansile lesion of the thoracic cord in size, extent and overall morphology as detailed.3.Unremarkable MRI of the lumbar spine other than moderate central spinal stenosis secondary to degenerative disease at L4-L5 level.