 Brain:Scattered small foci of white matter T2 hyperintensity are redemonstrated without significant interval change. No clearly new lesions are seen. No evidence of edema or mass effect is detected. Diffusion-weighted images are within normal limits. There are no findings to suggest acute intracranial hemorrhage or any abnormal extra-axial fluid collections. As on the prior examination, the medulla is slightly flattened and deviates to the right likely to accommodate the prominent vertebrobasilar junction.Cervical spine:The visualized spinal cord shows normal signal intensity and morphology. No focal lesions are seen. No epidural abnormalities are suspected.Since the prior MRI examination, anterior instrumented fusion has been performed from C5 through C7. Intervertebral devices have been placed at C5-6 and C6-7. Disc osteophyte complexes and associated spinal canal narrowing seen at these levels on the prior examination have resolved or improved. Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. No pathologic marrow replacement or edema is seen.C2-3: No spinal canal stenosis or neuroforaminal narrowing. C3-4: No spinal canal stenosis or neuroforaminal narrowing. C4-5: No spinal canal stenosis or neuroforaminal narrowing. C5-6: Postoperative findings. Improved spinal canal caliber without significant stenosis. Mild left foraminal narrowing. C6-7: Postoperative findings. Improved spinal canal caliber without significant stenosis. Mild left foraminal narrowing. C7-T1: No spinal canal stenosis or neuroforaminal narrowing. Lumbar spine:The first non rib-bearing vertebral body is designated L1. This yields 4 fully lumbar type vertebral bodies with a transitional L5 vertebral body.Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. Marrow signal characteristics of the lumbar spine are unremarkable. However, the sacral ala are edematous, particularly on the left where there is a thick band of traversing T1 hypointensity.The visualized distal spinal cord, conus and nerve roots of the cauda equina are unremarkable. No epidural abnormalities are seen.L1-2: No significant spinal canal stenosis or neuroforaminal narrowing. L2-3: No significant spinal canal stenosis or neuroforaminal narrowing. L3-4: Facet arthropathy with effusions. Mild bulging disc. No significant spinal canal or foraminal stenosis. L4-5: Facet arthropathy. Mild bulging disc. No significant spinal canal or foraminal stenosis. L5-S1: No significant spinal canal stenosis or neuroforaminal narrowing.
1.Scattered small lesions in the brain are unchanged compatible with the patient's stated history of multiple sclerosis. No definite evidence of any new lesion is seen. No acute intracranial abnormalities are detected.2.Interval anterior instrumented fusion has been performed from C5 through C7. Areas of spinal canal stenosis through this region seen on the prior examination have improved. No significant spinal canal stenosis is seen. No spinal cord abnormalities are detected.3.Edema is evident primarily within the left sacrum though to a lesser extent in the right sacrum as well. The pattern of the signal abnormality is suggestive of an insufficiency fracture. However, dedicated pelvic imaging is suggested to confirm this and exclude other etiologies.4.Relatively mild degenerative findings elsewhere in the lumbar spine without significant spinal canal or foraminal compromise.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.