Stage IV neuroblastoma, received 4 cycles of chemotherapy, assess response. Brain:The ventricles and sulci are within normal limits. The cisterns remain patent. There is no midline shift or mass effect. There are no areas of abnormal signal or pathological enhancement within the brain. There is no diffusion abnormality in the brain. No extra-axial fluid collection is identified. There is heterogeneous bone marrow signal throughout the skull with a few areas of focal signal abnormality such as in the left frontal bone and right occipital bone where there is enhancement suspicious for metastases. No significant change since prior. No large calvarial lesions or evidence of epidural tumor.Normal flow-voids are demonstrated in the major intracranial vascular structures. There is moderate mucosal thickening in the right sphenoid sinus which is new since prior. Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. There is heterogeneous but predominantly diffusely low T1 marrow signal as before. Small focus of contrast enhancement is present along the posterior and right aspect of the odontoid of the C2 vertebra. There is an enhancing lesion present between the spinous processes of C7 and T1 measuring 12 x 8 mm on sagittal STIR images, similar to prior. No new or enlarging osseous, epidural, or paraspinous lesion is appreciated in the cervical spine.The cervical spinal cord has normal signal characteristics and overall morphology.There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the cervical spine.The vertebral artery flow voids appear to be intact.MRI thoracic spine:The thoracic vertebral bodies are appropriate in the overall alignment. There is mild loss of vertebral body height at T6 and T10, compatible with pathologic fracture similar to prior. There is a heterogeneous signal present within the upper thoracic vertebrae. There is T1 signal hyperintensity throughout the vertebrae most prominent at T1, T5, T10, T11 and T12. There is contrast enhancement within T6, T8, and T10 centrally similar to prior.There are multiple enhancing posterior paraspinous soft tissue lesions present along the thoracic spine similar to prior. Most prominent of these is at the T2-T4 levels measuring approximately 13 x 27 mm in the sagittal plane, sagittal STIR image 11. Mild tumor extension into the left T4-5 neural foramen and left lateral epidural space is again seen. Minimal dorsal epidural tumor at the T8 level is also again evident without significant mass effect. The thoracic spinal cord has normal signal characteristics and overall morphology. No new or enlarging metastatic osseous lesion, epidural tumor, or paraspinous mass is appreciated.There is no significant disk bulge or herniation throughout the thoracic spine. No significant spinal canal stenosis at any level.Lumbar spine:The lumbar vertebral bodies are normal in overall alignment and height. The conus medullaris and distal spinal cord are normal. There are contrast enhancing foci present at L4. T1 hyperintensity involving the upper lumbar and lower thoracic vertebra compatible with prior radiation.There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the lumbar spine. There are marrow replacing lesions present within the iliac bones and sacrum similar to prior. An enhancing lesion is present in the left half of the sacral spinal canal, which is incomplete visualized on today's examination. The tumor involvement along the left sacral nerve roots, particularly surrounding the foraminal and extraforaminal left S1 nerve root was present on prior studies but incompletely imaged. Epidural tumor involving the left lateral aspect of the spinal canal at the S2 vertebral level appears slightly less conspicuous than on prior study from 7/28/2016, but may reflect slight differences in technique.No new or enlarging epidural tumor new osseous lesion or new paraspinous lesion is appreciated.
1. No significant change in osseous and paraspinous metastases, similar to prior examination from 8/29/2016. Metastatic lesions at T4-5 and T8 levels again demonstrate minimal epidural extension. Neural foraminal tumor is most conspicuous at the left T4-T5 level similar to prior. No evidence of mass effect on the cord or high-grade spinal canal stenosis at any level.2. No evidence of intracranial metastatic disease. Heterogeneous marrow of the calvarium with foci of enhancement as before.3. Partially visualized epidural tumor within the left sacral spinal canal and sacral neural foramina are grossly stable but incompletely imaged on current and prior studies. 