47-year-old male with sensory level at T6-7 level. Evaluate for multiple sclerosis flare up. MRI Brain:There is redemonstration of multiple periventricular and subcortical white matter lesions which are high signal on T2 and FLAIR and low signal on T1-weighted imaging. Several of the lesions, especially in the periventricular region have become more pronounced compared to the prior exam and some are new, for instance in the right posterior opercular region, right anterior frontal region and left periventricular regions. There is an additional lesion present in the right posterior pons which was also present on the prior exam.Mild supra and infratentorial volume loss again seen. Findings of inferior cerebellar vermis hypoplasia again seen. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma. Again demonstrated is evidence of congenital hypoplasia of the right ICA and basilar origin of the right MCA. The visualized portions of the paranasal sinuses demonstrate mild scattered mucosal thickening, particularly the bilateral maxillary sinuses. The visualized portions of the mastoid air cells are clear. MRI C-Spine:Examination is somewhat limited due to metallic hardware artifact from a previous multilevel laminectomy and posterior fusion with placement of lateral mass screws at multiple levels. Redemonstrated is congenital fusion at C5-C6 (as numbered previously, although there also appears to be partial C2-3 fusion) Again seen is straightening of the cervical lordosis and mild degenerative changes, not significantly changed form the prior exam. No significant spinal canal stenosis. The bone marrow signal is benign.Again demonstrated are multiple foci of T2/STIR hyperintensity in the cervical cord, most conspicuously spanning from C2 through C4 but also including the C7 level as before. No new lesions are appreciated in the cervical spine. The vertebral artery flow voids appear to be intact. The paraspinous soft tissue structures appear within normal limits. MRI T-Spine:There is congenital fusion of T1 and T2, as numbered in the cervical spine previously. There is also congenital fusion posteriorly involving the T8-T9 vertebral bodies. There are T2/STIR hyperintense lesions within the thoracic spinal cord most conspicuously involving the T9-T10 level. There may be additional smaller lesions more superiorly in the thoracic spine although evaluation is limited secondary to motion evaluation. The thoracic spine is in normal alignment. The vertebral body and disk heights are well-maintained. There is increased T2 signal anteriorly at the endplates of T9 and T10 which is degenerative in nature. Otherwise there is no worrisome focal marrow signal abnormality appreciated. There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the thoracic spine.
1.Compared to MRI dated 2/23/2016, there are multiple new bilateral T2/FLAIR hyperintense lesions in the periventricular and subcortical white matter consistent with progression of demyelinating disease.2.Multiple lesions in the cervical cord, without evidence of new lesion compared to prior cervical MRI from 9/30/2014.3.Additional lesions are visible within the thoracic spine (no prior thoracic comparison), most conspicuous at the T9-T10 level and also likely more superiorly although the exam is degraded by motion artifact.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.