Multiple sclerosis. Assess for disease progression. Both, the current and the previous examinations are limited by patient motion which limits comparison and detect small lesions.CERVICAL SPINE:Note lesions in the spinal cord are more conspicuous on the proton density sequence as the other sequences are more motion degraded.The posteriorly located midline T2-hyperintense lesion in the upper cervical spinal cord, at C2 level, is smaller than it was previously with resolution of the associated edema and mild cord expansion, consistent with evolution. Of note, the lesion was previously contrast-enhancing.A smaller midline posterior lesion at the upper C4 level remains unchanged since the prior examination.There is an additional small, more anteriorly located at midline lesion at C1, which is unchanged.Overall volume of the cervical spinal cord is preserved. The included brainstem and posterior fossa structures are unremarkable.There is mild multilevel degenerative cervical spondylosis manifested by shallow ventral indentations of the thecal sac by degenerative disc-osteophyte complexes at C4-C5, C5-C6 and C6-C7. There is no significant spinal canal stenosis, however. There is mild left C3-C4 and C4-C5 neural foraminal stenosis.THORACIC SPINE:There is a posteriorly located lesion at midline at T9-T10 level, which is unchanged. A more centrally located lesion at T6-T7 is also unchanged. A small left posterior-lateral lesion at the upper T4 level is difficult to reproduce on the prior examination but this may relate to the small size of the lesion.Otherwise, alignment is anatomic. The vertebral bodies are preserved in height. There is no suspicious marrow lesion. There is a small ventral indentation of the thecal sac by the T11-T12 disc associated with spinal canal narrowing. There is also significant neural foraminal stenosis.A small T2-hyperintense lesion in the right kidney is not completely assessed but may represent a cyst.
Current and prior outside examinations are significantly motion degraded. A few cervical and thoracic spinal cord lesions are not significantly changed since the prior examination. The largest lesion, at C2 level, shows resolution of the associated mild edema and cord expansion since the prior examination in 2011, when the lesion was contrast-enhancing, which is consistent with evolution. A small lesion at the upper T4 level cannot be discerned on the previous examination but this may relate to its small size. There is no clear evidence of interval progression of demyelinating disease in the cord.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.