Clinical question: History of cervical degenerative disease and metastatic sarcoma. Rule out cord compression. Signs and symptoms: Right upper extremity weakness. Pre and post enhanced cervical MRI:Examination demonstrates a tiny focus of T2 hyperintensity within the center of the cord at C1-C2 level without abnormal enhancement. Clinical significance of this finding is not clear.Foramen magnum is unremarkable.C2-C3 demonstrate degenerative changes with resultant severe right and moderate left neural foraminal compromise similar to prior exam.C3-C4 redemonstrate postoperative changes of an anterior fusion and placement of metallic plate and fixating screws anteriorly. Hypertrophic changes of posterior elements similar to prior exam are again noted. There is resultant circumferential mass effect on the cord with resultant flattening deformity and central spinal stenosis as well as bilateral neural foraminal compromise.. There is intrinsic cord T2/T2 STIR hyperintensity primarily on the right suggestive of myelitis. Compared to prior exams both on sagittal T2 and sagittal T2 STIR there is suggestion of slight interval decrease in the extent of this finding. This observation although could be technique related possibility of interval decreased edema of the cord since prior exam cannot be entirely excluded. Post enhanced images demonstrate patchy enhancement of the cord at this site which is best appreciated on axial series 1/1/2001 image 27 and sagittal post enhanced series 1001 image 9. This finding is consistent with myelitis.C4-C5 demonstrate stable degenerative changes of disc and the posterior elements and resultant mild central spinal stenosis and severe left and moderate right neural foraminal compromise similar to prior exam.C5-C6 demonstrate degenerative changes of disc and posterior elements resulting in mild central spinal stenosis and severe bilateral neural foraminal compromise similar to prior exam.C6-C7 redemonstrate stable degenerative changes without spinal stenosis.C7-T1 demonstrate stable mild degenerative changes without central spinal stenosis.Post enhanced images demonstrate no findings to suggest metastatic disease.
1.Tiny nonspecific central cord T2 hyperintensity stable since prior exam and without enhancement.2.Extensive degenerative changes and postoperative fusion at C3-C4 with central spinal stenosis demonstrate no change since prior study. Focus of intrinsic T2 hyperintensity on the right aspect of the cord at this level demonstrate patchy internal foci of enhancement and is believed to represent myelitis. There is apparent decreased extent of hyperintensity of the cord at this level compared to prior exam which could be technique related, however possibility of interval decreased cord edema cannot be entirely excluded. Please correlate with neurological status.3.Extensive degenerative changes of cervical spine remains stable since prior exam from April 2015.4.Examination demonstrates no evidence of malignancy/metastatic disease.