Multiple sclerosis, evaluate for progression Brain: Examination is compared to prior MRI from 1/24/2011 which was obtained per treatment planning protocol and includes axial FLAIR sequences. Again seen are confluent and patchy foci of T2/FLAIR hyperintensity throughout the bilateral periventricular and subcortical white matter. Multiple infratentorial lesions including the midbrain, pons, and medulla as well as the middle cerebellar peduncles and the bilateral cerebellar hemispheres are also again seen. Morphology and distribution of these lesions is again consistent with known demyelinating disease. Due to technique differences, comparison with small lesions is limited. There is however suggestion of mild interval increase in T2/FLAIR hyperintensity in the left parietal periventricular white matter, series 401 axial FLAIR image 18, as well as a lesion in the right cerebellar hemisphere, axial FLAIR image 9, which were not present previously. There are no new large lesions.There is moderate degree of global parenchymal volume loss including diffuse thinning of the corpus callosum. There is moderate burden of T1 hypointense lesions. No intracranial mass or mass effect. No evidence of infarct or hemorrhage. Calvarium and extracranial soft tissues are grossly unremarkable.Cervical spine: Cervical spine sequences are motion degraded. There are multiple T2/STIR hyperintense lesions throughout the cervical cord including at the C1 level bilaterally, confluent signal abnormality from the mid C2 to the C3-C4 level, as well as a lesion extending from C4-C5 to C5-C6.Vertebral body heights and alignment in the cervical spine are maintained. Fairly mild multilevel degenerative changes are present including small disc osteophyte complexes at the C3-C4, C4-C5, and C5-C6 levels. There is no significant spinal canal or neural foraminal stenosis at any level.
1. Again seen are numerous supra- and infratentorial lesions consistent with known demyelinating disease. Comparison of small lesions is limited due to differences in techniques. There is however question of slight progression since 1/24/2011, with small foci of T2/FLAIR hyperintensity in the left parietal periventricular white matter and right cerebellar hemisphere not definitively seen previously. No new large lesions. 2. Moderate degree of global parenchymal volume loss and a moderate burden of T1 hypointense lesions.3. Multiple demyelinating lesions in the cervical cord. No prior cervical spine MRI is available for comparison.