Progressive multiple sclerosis. Worsening lower extremity weakness. Cervical: Artifacts and slight differences in technique make assessment difficult however compared to 10/13/2012, there appears to be increase in patchy T2 signal abnormality in the cervical cord at the C2 level as well as in the mid to lower cervical cord extending into the thoracic cord. Vertebral body heights are maintained. There is minimal retrolisthesis of C5 on C6. Alignment is otherwise maintained. There is mild spinal canal stenosis at the C6-C7 level. No high-grade spinal canal stenosis. There is mild to moderate left C4-C5, moderate left greater than right C5-C6, and moderate left and mild right C6-C7 neural foraminal stenosis related to uncovertebral hypertrophy.Thoracic: No recent thoracic MRI is available for comparison but compared to 10/13/2012, there appears to be interval increase in patchy areas of T2 hyperintensity in the upper, mid, and distal thoracic cord. Although slight differences in technique limit comparison, overall findings are suspicious for progression. There is T2 hyperintensity involving the ventrolateral aspects of the cord suggesting Wallerian degeneration along the lateral corticospinal tracts. Artifacts on the post gadolinium sequences limits assessment, but there is suggestion of mild enhancement in the distal thoracic cord, sagittal series 19 image 11.Vertebral body heights and alignment in the thoracic spine are normal. No significant spinal canal or neural foraminal stenosis is appreciated. Bone marrow signal is benign.
Although artifact and differences in technique limit comparison, there is overall suggestion of progression of demyelinating disease in the cervical and thoracic cord compared to 10/13/2012. There is also suggestion of mild enhancement in the lower thoracic cord which may be related to recent active demyelination.