21 years, Male, history of myxopapillary ependymoma status post radiation therapy. Also history of cavernous malformations. Evaluate for changes.. MRI brain:Redemonstrated are innumerable punctate foci of susceptibility throughout the brain which are not appreciably changed since prior brain MRI on 3 Tesla at 3/21/2016. No enlarging lesions. No new edema or acute or subacute blood products to suggest new hemorrhage. More prominent hemosiderin staining involving the left precuneus is again seen related to hematoma seen in this location on MRI dated 12/8/2015. No evidence of acute infarct. A few nonspecific scattered punctate foci of FLAIR hyperintensity are again seen. No abnormal enhancement. No intracranial mass effect, midline shift, or herniation. Ventricles are normal in size. Visualized calvarium and extracranial soft tissues are grossly unremarkable.MRI spine:There are punctate foci of T2 hypointensity in the cervical cord including the right lateral C2 level right dorsolateral C3 level. There is more questionable subtle linear low T2 signal along the surface of the cord at the C5 level and C6-C7 level although artifact remains a possibility. These findings are not definitively appreciated on prior study although slight differences in technique/scanner may account for this.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 since at least 11/23/2014. There is also 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 back to at least 11/23/2014. The left ventral C1 level focus of enhancement along the surface of the cord is stable. Foci of enhancement along the dorsal and lateral surface of the distal thoracic cord appear slightly decreased in conspicuity although slight differences may reflect contrast timing. Linear focus of enhancement in the thecal sac at the L1 level is not appreciably changed. A small rounded enhancing lesion along the left cauda equina at the L2 level measuring 8 x 5 mm mm is not significantly change. Small enhancing nodule at the S1 level is also not significantly changed. More ill-defined diffuse enhancement in the lumbar thecal sac is favored to reflect differences in contrast timing and similar to study from 6/22/2015. Postoperative changes relating to lumbar laminectomies are redemonstrated. Small central disc protrusion at the T4-T5 level is also similar to prior. Lumbar degenerative changes including disc bulges and facet arthropathy which contribute to multilevel mild to moderate neural foraminal stenosis again seen. Mild narrowing of the thecal sac at the L3-L4 also again seen. No high-grade spinal canal stenosis at any level.
1. Brain MRI again demonstrates innumerable foci of susceptibility effect throughout the brain which may represent cavernous malformations related to radiation therapy. No significant change since MRI brain at 3 Tesla on 3/21/2016. No findings to suggest interval hemorrhage.2. Punctate foci of low T2 signal in the cervical cord are also compatible with posttreatment change/cavernous malformations. These are not appreciable on the prior spine MRI from 12/8/2015. Given their small size, this finding may reflect technique/scanner differences.3. Overall no significant change in nodular foci of enhancement within the thecal sac which given stability are favored to represent treated leptomeningeal disease. Slight differences in thecal sac enhancement compared to 12/8/2015 are favored to be related to contrast timing, with the overall appearance on current study not appreciably changed since 6/22/2015. No evidence of tumor progression. 