Clinical question: Any change in schwannoma at C7 -- T1 or other tumors. Signs and symptoms: NF Type 2. cord compression, multiple meningioma schwannomas and worsening gait. Pre-and post-enhanced cervical MRI:Examination is severely limited to nearly nondiagnostic in particular on post enhanced series due to extensive motion artifact. Post-enhanced series was repeated however without improvement of image quality due to motion and the exam was eventually terminated by patient.There also note prior MRI of cervical spine for comparison.Within the indication examination demonstrate multiple small foci of T2 stir hyperintensity throughout the cervical cord some with resultant subtle focal bulge of the cord and consistent with neurofibromas. The subarachnoid space surrounding cord however is still preserved and no significant spinal canal compromise detected. The lesions demonstrate enhancement on post infused images.There is a large intramedullary enhancing mass centered at T1 -- T2 disk level with resultant expansion of the cord and complete effacement of subarachnoid space consistent with a previously known intra-neurofibroma. Considering suboptimal quality of images there is no convincing evidence of any significant change in the size of this lesion since prior study. There is no appreciable neural foraminal widening at any level. Foramen magnum is unremarkable. Partially visualized posterior fossa demonstrate a well demarcated mass along the inferior surface of tentorium consistent the patient's previously known meningioma. It measures approximately 26 x 22 mm on sagittal T2 weighted images compared to prior study from 2014 measurement of approximately 26 x 25 mm.A previously known large right cerebellopontine angle meningioma is also again partially visualized and appears grossly similar to prior exam measuring maximal 24 x 24-mm on sagittal T2 weighted series.Pre-and post enhanced thoracic MRI:Examination redemonstrate a bone detailed intramedullary enhancing neurofibroma at T1 -- T2 disk level with resultant expansion of the cord and complete effacement of subarachnoid space. No convincing interval change in the size of this lesion since prior study.A posterior dural -based enhancing meningioma at lower T4 level with significant mass-effect and forward displacement of the cord and central spinal stenosis is again identified and without convincing evidence of change. It measures approximately 14 mm in cranial cephalad and 9.5-mm in AP axis. The compressed cord at this level demonstrate no definitive evidence of cord signal abnormality.Multiple tiny additional neurofibromas on the surface of the cord at T7 and T10 through T12 are again identified and without significant change. No evidence of central spinal stenosis at any other level other than T4 level.Incidental note is made of minimal bilateral pleural effusion. There is a single locule well demarcated cyst along the superior aspect of the left kidney measuring approximately 30 mm contrast is diameter and demonstrate interval increased since prior study measurement of approximately 25.
1.MRI examination of cervical spine is suboptimal due to motion artifact. Multiple small intra-medullary enhancing neurofibromas are identified. No spinal stenosis or neural foraminal compromise. Limited view of posterior fossa partially demonstrate stable meningioma in the right cerebellopontine angle and along the inferior surface of tentorium on the left.2.MRI of thoracic spine demonstrate a stable intramedullary expansile cord lesion at T4 level with resultant complete effacement of subarachnoid space. Stable posterior dural based meningioma at T4 with significant mass effect, flattening and forward displacement of the cord and central spinal stenosis. Multiple additional superficially located neurofibromas of the cord without significant change since prior exam. Slight interval increased size of a single locule cyst along the superior left kidney since prior exam. Minimal bilateral pleural effusion.