History of right L5 nerve sheath tumor. Assess for schwannomas. CERVICAL SPINE:There is partial straightening which may relate to patient position. Sagittal alignment is otherwise anatomic. The vertebral bodies are preserved in height. There is moderate disc height and T2 signal loss at C6-C7 associated with degenerative endplate disease. There is mild disc desiccation but no significant height loss at the other levels. Very shallow ventral indentations of the thecal sac by the disc-osteophyte complex is present at C6-C7 and to lesser extent at C4-C5. At C6-C7, there is mild-to-moderate right and mild left neural foraminal stenoses by uncovertebral and, to a lesser extent, facet arthropathy. Neural foramina at the other levels are preserved. The cervical spinal cord shows normal signal and shape. Following contrast injection, there is no abnormal enhancement in the spinal cord or the cervical nerve roots. Included posterior fossa is unremarkable.THORACIC SPINE:Of note, the patient has atypical segmentation with only 11 ribs, assuming ribless T12. Thoracic spinal alignment is anatomic. The vertebral bodies are preserved in height. Marrow signal is heterogeneous, in part because of fat-containing lesions involving the T6, T7 T10, and T11 vertebrae, which probably represent hemangiomata, in addition to type 2 degenerative signal in the marrow subjacent to the endplates at T8-T9 anteriorly. There is no suspicious marrow lesion. Small intravertebral disc herniations (Schmorl nodes) are present at T7-T8. There is no significant posterior bulging or osteophytosis and the spinal canal is preserved. There is mild proliferative right T10-T11 facet arthropathy resulting in very mild neural foraminal stenosis. The other foramina are preserved. The thoracic spinal cord also shows normal signal and shape. Following contrast injection, there is no abnormal contrast enhancement within the thecal sac.Lungs show dependent changes. Well-circumscribed T1-hypointense, T2-hyperintense, noncontrast enhancing liver lesions likely represent cysts but are not completely assessed.LUMBAR SPINE: Of note, the patient has atypical segmentation with only 11 ribs. Assuming ribless T12, there are only 4 lumbar vertebrae. There is no significant malalignment. The vertebral bodies are preserved in height. There is disc desiccation at L2-L3, L3-L4 and L4-L5 associated with small bulges. There is mild height loss at L3-4. Degenerative facet arthropathy is present at these 3 levels but is more pronounced at L4-L5 and L3-L4, which is associated with small effusions and edema and enhancement in the marrow and adjacent soft tissues but only mild left neural foraminal stenosis. The left L3-L4 facet is also associated with a small dorsal cyst. There is abnormal contrast enhancement in the L2-L3 interspinous ligament with associated remodeling of the spinous processes, compatible with Baastrup disease. Mild similar changes are present at L1-L2 as well.The conus has normal shape and signal. The tip of the conus is at upper L1 level. There is no abnormal contrast enhancement within the thecal sac.There is a well-circumscribed, T1-hypointense, T2-hyperintense, contrast-enhancing just anterior to the first right sacral foramen (L5 by the above described level nomenclature), which measures up to 3.5 cm.
1.Cervical: No schwannoma, ependymoma or meningioma. Mild degenerative disease at C6-C7 as described above.2.Thoracic: No schwannoma, ependymoma or meningioma. Mild degenerative disease of the right T10-T11 facet and the anterior T8-T9 endplate. Of note, the patient has atypical segmentation with only 11 ribs. Assuming ribless T12, there are 4 lumbar vertebrae. Incidental, incompletely assessed probable liver cysts are present.3.Lumbar: While there is no abnormal contrast enhancement in the spinal canal, a 3.5 cm Contrast-enhancing mass anterior to the right first sacral foramen (right L5 nerve root by the above-described level nomenclature) would be most compatible with isolated nerve sheath tumor, such as schwannoma or neurofibroma. Otherwise, there is multilevel lower lumbar facet arthropathy associated with effusions and marrow/adjacent soft tissue edema. There is also Baastrup disease at L2-L3.