Clinical question: Ependymoma? AML? Leptomeningeal spread? Signs and symptoms: Right arm weakness. Pre and post enhanced brain MRI:No diffusion-weighted abnormalities.Mild uniform prominence of cortical sulci and cerebellar-vermian folia and mild prominence of the lateral ventricles for patient's stated age with maintained midline remains similar to prior exam 1-30-2015. No evidence of edema or mass effect and no detectable abnormal parenchymal or leptomeningeal enhancement.Mild to moderately dilated fourth ventricle and postoperative changes of right sided suboccipital craniectomy remain similar to prior exam and without abnormal enhancement.The signal void of major intracranial arterial branches are unremarkable.Unremarkable images through the orbits which includes axial fat sat post enhanced series.Unremarkable images through the paranasal sinuses.Significant interval improvement of opacification of bilateral mastoid air cells since prior study.Pre and post enhanced cervical MRI:There is signal abnormality of the skull base and C2 consistent with prior radiation change.Post operative changes of a chronic suboccipital craniectomy.Normal anatomical alignment of the vertebral column and with no detectable foci of abnormal signal intensity or abnormal enhancement.Normal signal intensity and caliber of the cervical and upper most visualized thoracic cord without abnormal enhancement to suggest metastatic disease.There is a tiny epidural defect at T1-T2 disc level on the left (sagittal T2, T2 STIR image 7 and sagittal T1 pre and post image 6) with questionable enhancement which is believed to represent a small disc/osteophyte. Finding is not associated with spinal stenosis or neural foraminal compromise.
1.Brain MRI demonstrated no evidence of recurrence of tumor or to meningeal carcinomatosis. Parenchymal volume loss as detailed. Interval significant improvement of bilateral mastoid air cell opacification with minimal residual.2.Cervical MRI demonstrate no evidence of metastatic disease. Small left disc/osteophyte at T1-T2 level. No spinal stenosis or neural foraminal stenosis. Post operative and radiation changes as detailed.