Clinical question: Thoracic spine lesion; follow-up progression. Signs and symptoms: Paresthesias. Nonenhanced thoracic MRI:Examination redemonstrate a stable expansile lesion of thoracic cord with hypointense T1 and hyperintense T2 signal intensity. The lesion extends from approximately T3-T4 disc level inferiorly to immediately below the T6-T7 disc level which is identical to prior exam. Similar to prior exam from the superior extent of this expanded lesion tiny focus of T2 hyperintensity extends further superiorly to approximately mid T2 level. The signal intensity of cord surrounding this lesion remains within normal. The appearance is suggestive of a syrinx. There are subtle ventral indentation of the cord at multiple levels including at the level of expanded lesion secondary to degenerative disc disease which has also remained identical to prior study. Previously mentioned internal foci of T2 hyperintensity within this finding are no longer identified and believed to have been secondary to pulsation artifact and not a true finding.Mild-to-moderate degenerative disc disease and with loss of intervertebral disc heights and multilevel shallow ventral hypertrophic changes/bulging discs remain identical to prior exam. The ventral epidural degenerative changes resulting in multilevel mild indentation of the ventral aspect of the cord including at the level of expanded lesion which are also fairly similar in appearance to prior exam.
1.Well-demarcated expansile lesion of thoracic cord remains stable since prior exam. The finding is highly suggestive of a syrinx. Possibilities of a mass is considered very unlikely however further follow-up is recommended. The signal intensity of the cord is otherwise unremarkable. Please see above comments.2.Degenerative changes of thoracic spine and with resultant multilevel ventral epidural defects (bulging disc and spurs) results in subtle indentation of the ventral aspect of the cord which has also remained stable since prior exam.