Female, 67 years old, with myelitis. Cervical:Redemonstrated is non-expansile, non-enhancing T2 hyperintensity affecting the upper cervical cord. This finding is most prominent from C2 through C4. Below C4, this abnormality seems to have become less conspicuous when compared to the prior examination. No pathologic intrathecal enhancement is detected.Spinal alignment is anatomic. Vertebral body heights are preserved. There is partial fusion of the C5 and C6 vertebral bodies. Marrow signal characteristics and pattern of enhancement are normal.C2-3: Unremarkable. C3-4: Small posterior disk osteophyte which mildly contacts the ventral cord. No significant generalized spinal canal stenosis. No significant neuroforaminal narrowing.C4-5: Broad posterior disk osteophyte formation resulting in a moderate generalized spinal canal stenosis and ventral cord flattening. Severe right and moderate left foraminal narrowing. No interval changes.C5-6: Obliteration of the disk space. No significant spinal canal stenosis. Mild left foraminal narrowing. No interval changes.C6-7: Minimal posterior disk osteophyte formation. No significant spinal canal stenosis. Moderate left foraminal narrowing. No interval changes.C7-T1: Unremarkable. Thoracic:The spinal cord shows grossly unremarkable morphology and signal characteristics. Although image quality is not adequate to exclude very mild or subtle abnormalities, no large regions of signal abnormality are suspected, and the appearance of the cord is unchanged relative to the prior exam. No pathologic enhancement is seen.There is a very slight scoliotic curvature of the thoracic spine. Vertebral body heights are preserved. No marrow replacement or evidence of marrow edema is seen.Mild degenerative disk disease is seen at T7-8, T8-9 and T9-10 with loss of disk height and disk bulging with a protrusion at T9-10. No significant spinal canal or neuroforaminal stenosis is seen.Lumbar:The visualized spinal cord, conus and cauda equina show normal morphology and signal characteristics. No convincing pathologic intrathecal enhancement is seen.There is a mild scoliotic curvature of the lumbar spine. Vertabral body heights are preserved.The L2-3 disk space shows abnormal increased T2 signal with mild T2 signal extending to the adjacent endplates. Patchy ill-defined enhancement is also seen along the endplates.No other disk space demonstrates pathologic T2 signal. There is elevated T1 signal within the L4-5 disk space reflect proteinaceous degeneration or mineralization. Elsewhere, no definite pathologic marrow enhancement is seen.No discrete or enhancing paraspinal fluid collections are seen. There is some fluid tracking fluid along the fascia of the upper lumbar region. There may also be some edema within or along the anterior paraspinal soft tissues. In particular, the right psoas muscle seems to be slightly edematous and T2 hyperintense relative to the left. Free pelvic fluid is also partially visualized.T11-12: Small right paracentral disk protrusion. No spinal canal and foraminal stenosis.T12-L1: Small left paracentral annular fissure. No spinal canal or neuroforaminal stenosis.L1-2: Facet hypertrophy. Mild bulging disk. No significant generalized spinal canal stenosis. No significant neuroforaminal narrowing. L2-3: Mild facet hypertrophy and ligamentum flavum thickening. Moderate bulging disk. Mild generalized spinal canal stenosis. Moderate right and mild left foraminal narrowing. L3-4: Moderate facet hypertrophy and ligamentum flavum thickening. Minimal bulging disk. No spinal canal stenosis. Moderate right foraminal narrowing. L4-5: Marked facet hypertrophy. Mild bulging disk. Effacement of the left ventral thecal sac but no significant generalized canal stenosis. Moderate left foraminal narrowing.L5-S1: Marked left and moderate right facet hypertrophy. Minimal bulging disk with bilateral paracentral annular fissures. No significant spinal canal or neuroforaminal stenosis.
1. Non-expansile, non-enhancing T2 signal abnormality affecting the cervical spinal cord is again seen, and this appears to have improved somewhat relative to the prior examination. No definite additional areas of cord signal abnormality are seen. The differential diagnosis continues to include an infectious or postinfectious process, or a noninfectious inflammatory/autoimmune phenomenon.2. T2 hyperintensity is seen within the L2-3 disk space with mild signal abnormality in the adjacent endplates and mild associated patchy enhancement. Although this finding and could represent an inflammatory component of degenerative disk disease, the possibility that this represents diskitis osteomyelitis must also be considered. The presence of paraspinal edema, for example involving the right psoas muscle, would also support the possibility of an infectious process.