17 years, Male, boy with NF1 and very frequent headaches and neck pain. Kyphosis and low back pain. History of renal artery stenosis, evidence of moyamoya? MRI BRAIN: There is a nonspecific focus of T2/FLAIR hyperintensity involving the left dorsal medulla. Additional foci of T2/FLAIR hyperintensity are seen involving the bilateral cerebellar hemispheres and the right thalamus. Prior outside study from 5/21/2013 is motion degraded however the right thalamic, the right cerebellar, and left dorsal medullary foci were present previously. Apparent foci of T2/FLAIR hyperintensity involving the brainstem including the cerebral peduncles and left periaqueductal region are less conspicuous compared to prior study and at least in part artifactual. No discrete intracranial mass or mass effect is evident. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No midline shift or herniation. The ventricles are within normal limits in size and configuration. Dedicated orbital sequences were not obtained however there is mild diffuse enlargement of the left optic nerve and similar to prior. Paranasal sinuses and mastoid air cells are clear. Calvarium and extracranial soft tissues are grossly unremarkable.MRA BRAIN: The intracranial internal carotid arteries demonstrate no significant stenosis. The middle and anterior cerebral arteries are also patent. The vertebral arteries, basilar artery, and posterior cerebral arteries also are patent with no significant stenosis. No evidence of aneurysms or vascular malformations. No findings to suggest moyamoya.CERVICAL SPINE: Lack of contrast limits evaluation for small lesions. Vertebral body heights in the cervical spine are normal. There is scalloping involving the left dorsal aspect of the C7 vertebral body related to dural ectasia. There is loss of cervical lordosis and levoscoliosis of the cervical spine centered at the C6-C7 level, which may be in part positional. Bone marrow signal is benign.There is mild congenital narrowing of the cervical spinal canal. No evidence of cord signal abnormality or intramedullary mass. No discrete mass or enlargement of the cervical neural foramina is appreciated. There is no spinal canal or neural foraminal stenosis.THORACIC SPINE: There is dorsal scalloping involving multiple upper thoracic vertebrae related to dural ectasia. There is mildly exaggerated thoracic kyphosis. Alignment of the thoracic spine is otherwise maintained. Vertebral body heights are normal with small multilevel Schmorl's nodes noted. Bone marrow signal is benign.No abnormal signal is seen involving the thoracic cord or evidence of intramedullary mass. There is outpouching involving multiple left upper thoracic neural foramina with CSF attenuation compatible with lateral thoracic meningoceles and measuring up to 2 cm in diameter. There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the thoracic spine.Left kidney is noted to be atrophic with suggestion of compensatory enlargement of the right kidney. There is a trace right pleural effusion.
1. MRI brain demonstrates scattered supra- and infratentorial foci of T2/FLAIR hyperintensity compatible with foci of abnormal signal intensity related to known NF1; many of these are also evident on prior brain MRI with slight differences in technique limiting comparison. No discrete mass or intracranial mass effect is appreciated.2. Dedicated orbital sequences were not obtained however there is suggestion of mild, diffuse enlargement of the left optic nerve, grossly similar to prior, but suspicious for an optic nerve glioma. Consider dedicated orbital MRI for better assessment.3. MRA head demonstrates no significant stenosis in the intracranial vasculature. No evidence of moyamoya.4. MRI of the cervical and thoracic spine demonstrate stigmata of NF 1 including dural ectasia, particularly in the upper thoracic spine, and multiple left upper thoracic lateral meningoceles measuring up to 2 cm in diameter. No discrete intraspinal, neural foraminal, or paraspinous mass is evident within the limits of noncontrast study. 5. There is suggestion of cervical levoscoliosis with apex at the C6-C7 level which can be correlated with upright radiographs. There is slightly exaggerated thoracic kyphosis which is also evident on prior radiographs from 2014.