Acute lymphocytic leukemia. Progressive lower extension weakness, over 3 months duration. History of lumbar puncture 1 day prior to this MRI. Compared to the previous examination, there is suggestion of minimal/subtle increased contrast enhancement along the cauda equina roots which is nonspecific in this setting, as it may represent a reactive or inflammatory process to medications or lumbar puncture. The contrast enhancement is not nodular or masslike.Relatively more intense, linear contrast enhancement on the left side of the upper lumbar thecal sac along the left L3 nerve root was present previously and likely represents a radicular vein.There is contrast enhancement relating to the most caudal part of the thecal sac at S2 level which is unchanged and likely vascular/normal in etiology.The conus medullaris itself shows normal signal. The spinal canal is preserved.Alignment is notable for unchanged minimal retrolisthesis of L1 relative to L2 which is associated with desiccation and mild disc height loss. The other intervertebral discs are preserved in height. The vertebral bodies are preserved in height. There is no foraminal stenosis. Marrow signal is preserved. Contrast enhancement and stranding in the posterior subcutaneous tissues extending along the L2-L3 interspinous space is probably related to recent lumbar puncture. This is associated with slightly focal underlying posterior dural thickening which is probably reactive. There is no epidural collection.There are changes of presumed bone marrow biopsies in the posterior iliac bones.
1.There is minimal contrast enhancement involving the cauda equina nerve roots without thickening or nodularity. Finding is nonspecific given history of lumbar punctures and chemotherapy for CNS leukemia. Finding may be attributed to an inflammatory process such as Guillain-Barré Syndrome, but would be better correlated with clinical/CSF findings. No nodular leptomeningeal enhancement to suggest leukemia by imaging. 2.Minimal degenerative changes in the lumbar spine without significant spinal canal foraminal stenosis at any level. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.