Reason: Astrocytoma, s/p RT now on TMZ. History: astrocytoma. CERVICAL SPINE:There is mild reversal of the normal cervical lordosis. Vertebral body heights are intact. Mild multilevel disc desiccation with and mild degenerative disc disease at C5-C6 and C6-C7 is unchanged. Diffuse T1 hyperintensity throughout the vertebral bodies suggests prior radiation. Postsurgical changes along the posterior cervical spine with laminectomies at C5 and C6 are unchanged.T2 hyperintense expansile mass within the right aspect of the cord extending from the C3-C4 level to C7-T1 is overall unchanged in size measuring approximately 1.5 x 1.2 cm in transverse dimension (701/12) and 4.9 cm in length. There is some T2 hyperintensity also on the left side of the cord at these levels, unchanged. Mild effacement of the surrounding subarachnoid space, particularly at C5, is unchanged. There is subtle enhancement within the right ventral aspect of the midportion of the lesion at C5-C6, seen in both the axial and sagittal planes (1901/7, 2001/12) which was not definitely evident on the prior exams. It is more conspicuous on the axial delayed postcontrast images.THORACIC SPINE:Alignment is anatomic. Vertebral body heights and discs are intact. There are diffuse marrow changes related to prior radiation. Conus terminates at T12-L1.T2 hyperintense expansile mass centered on the left aspect of the cord extending from the T2-T3 level to the T8 level is unchanged in size and overall distribution, measuring 1.2 x 0.9 cm in transverse dimension and 11.4 cm in length. No enhancement is seen within the lesion. No significant spinal or neural foraminal narrowing throughout the thoracic spine. Central disc osteophyte complex at T7-T8 appears decreased from the prior exam. Other scattered mild spondylotic changes appear similar.
Cervical and thoracic astrocytomas are unchanged in extent. There is subtle questioned enhancement within the cervical intramedullary mass at C5-6 seen in two planes, which was not definitely present on the prior exam. Close attention should be made to this region on follow-up exams, to exclude the possibility of malignant degeneration.