21 years, Male, history of myxopapillary ependymoma status post radiation therapy. History of cavernous malformations. There are again punctate foci of T2 hypointensity in the cervical cord including the right lateral C2 level right dorsolateral C3 level. Previously noted questionable subtle linear low T2 signal along the surface of the cord at the C5 level and C6-C7 level is not well visualized on this examination. Diffuse postradiation marrow changes are again noted. The enhancing 12 mm STIR hyperintense lesion in the posterior-superior aspect of C7 vertebral body is unchanged since at least 11/23/2014. A stable region of irregular marrow enhancement and STIR hyperintensity in the left posterior T6 vertebral body minimally extending into the left pedicle also appears similar 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 are again noted, appearing more similar to the examination of 12/08/15 rather than the immediate prior examination of 06/20/16, perhaps due to differences in technique. The linear focus of enhancement in the thecal sac on the left 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 diffuse enhancement in the lumbar thecal sac is favored to reflect differences in contrast timing and is similar to study from 12/8/2015. Postoperative changes relating to lumbar laminectomies are redemonstrated. Small central disc protrusion at the T4-T5 level is not significantly changed. 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. Punctate foci of low T2 signal in the cervical cord, compatible with posttreatment change/cavernous malformations, not significantly changed since 6/20/2016.2. No significant change in nodular foci of enhancement within the thecal sac which given stability are favored to represent treated leptomeningeal disease. No definite evidence of tumor progression. 