 BRAIN: There has been overall worsening in numerous (greater than 20) demyelinating lesions, many of which enhance (approximately 13). There is a larger lesion in the right aspect of the medulla (series 701 image 4). Posterior fossa lesions have worsened from the prior examination overall with multiple lesions involving bilateral middle cerebellar peduncles (some new), a new lesion in the left cerebellar hemisphere, and a new lesion in the right midbrain (series 701 image 10). There is a new enhancing lesion in the left medial cerebellar hemisphere on series 3601 image 8/series 701 image 8. There appears to be a new lesion in the left thalamus on series 701 image 13. There is worsening of lesion in the left corona radiata on series 70 on image 15 with enhancement. There is a dominant new rounded lesion in the right corona radiata on series 701 image 16 with enhancement. There is a new rounded lesion in the left superior frontal gyrus on series 701 image 18 with enhancement. There is a new rounded lesion in the right centrum semiovale on series 701 image 18 with enhancement. Many of the lesions show high diffusion signal without corresponding low ADC signal. While this limits sensitivity of diffusion images, no definite focus of true restricted diffusion is seen to suggest acute infarction. There is no significant mass effect or midline shift. Several lesions with T1 hypointensity again seen.None of the enhancing lesion seen on the prior exam appear to enhance on current exam. Once again there is extensive involvement of the corpus callosum and the periventricular white matter as noted on the prior exam. There is demyelination involving the periaqueductal region.A lesion in the right temporal lobe has resolved, previously seen on series 401 image 14.There is no hydrocephalus.THORACIC: There is normal alignment of the thoracic spine. The vertebral body osseous marrow signal is low on T1 diffusely without a discrete lesion. This may be secondary to marrow infiltrative process of any cause; clinical correlation is advised. There is no significant disk herniation or spinal canal stenosis and thoracic spine.There is a non-expansile high T2 signal thoracic cord lesion extending from mid T8 vertebral body to mid T9. There is a second similar cord lesion at inferior aspect of T10 vertebral body extending to the mid aspect of T11. There is some intrinsic T1 hyperintensity and possible mild enhancement of these lesions, better appreciated on the sagittal sequence.
1.Overall interval worsening with numerous (greater than 20) demyelinating lesions, many of which enhance (approximately 13). Multiple new/worsened lesions involve the brainstem, cerebellum, as well as the supratentorial brain as detailed above.2.Two discrete demyelinating lesions in the mid to lower thoracic cord with mild enhancement also seen.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.