History of lymphoma with brain and spine lesions on recent PET. Brain: No intracranial mass or mass-effect. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild chronic small vessel ischemic changes. More focal area of FLAIR hyperintensity seen in the left periatrial white matter with adjacent dilatation of the left lateral ventricle atrium which is favored to be on an ex vacuo basis. There is minimal prominence of the ventricular system which is likely related to volume loss although component of communicating hydrocephalus cannot entirely be excluded.. No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved. Mild mucosal thickening is noted throughout the paranasal sinuses, which are otherwise clear.Small enhancing lesions with low T1 hyperintensity are noted in the right frontal calvarium including the right superior orbital wall. T1 hypointensity and enhancement is also noted involving the clivus/basiocciput and occipital condyles.Complete spine:There is diffuse low T1 marrow signal throughout the cervical, thoracic, and lumbar spine with multiple more focal areas of T2 hyperintensity and enhancement noted. Relatively more prominent of these are at the C2 and C4 vertebral bodies in the cervical spine and essentially all levels in the thoracic and lumbar spine. Posterior elements are also involved. Abnormal marrow signal with heterogeneous enhancement is also noted in the visualized ribs, sternum, and pelvis.Degenerative changes are seen throughout the cervical spine with relatively more prominent disc osteophyte complex at the C5-C6 level which mildly indents the left ventral cord. Minimal disc osteophyte complex also seen at the C6-C7 level. There is mild to moderate left-sided neural foraminal stenosis at this level. Mild degenerative changes are also seen in the lumbar spine with multilevel small disc bulges and small central protrusion at the L5-S1 level. There is mild right foraminal narrowing oat L3-L4 and L4-L5.No high-grade spinal canal or neural foraminal stenosis is appreciated at any level in the cervical, thoracic, or lumbar spine.. No cord signal abnormality or evidence of epidural tumor.Nonspecific T2 hyperintense lesion involving the subcutaneous tissues in the midline posterior neck at the C6 level. Large left clavicular mass is partially visualized. Minimal bilateral pleural effusions.
1. No intracranial mass or abnormal parenchymal or meningeal enhancement to suggest neoplasm. There are mild chronic small vessel ischemic changes. There is also more focal area of FLAIR hyperintensity involving the left periatrial white matter compatible with gliosis, possibly related to treatment change versus remote ischemic injury. No associated enhancement, restricted diffusion, or mass effect to suggest active lymphoma in the brain. No discrete lesion within the nasal cavity is appreciated.2. Extensive bone marrow signal abnormality involving the cervical, thoracic, and lumbar spine as well as the right frontal calvarium with multifocal areas of T2 hyperintensity and enhancement. Findings are consistent with known lymphoma. Comparison with prior brain and spine MRI would be helpful if available. No compression fractures, epidural tumor, or cord signal abnormality. 