 This exam is limited due to lack of contrast as well as incomplete spinal imaging due to the patient terminating the exam prior to completion.BRAIN: There are postoperative findings related to occipital craniotomy. There is a right frontal approach ventriculostomy catheter terminating near the foramen of Monro. The ventricles are nondilated. There is a subcentimeter focus of decreased diffusion centered within the left precentral gyrus with surrounding T2 hyperintensity as well as additional foci of T2 hyperintensity and central T2 hypointensity within the right insula and right temporal lobe. There is an additional punctate focus of T2 hyperintensity within the right frontal subcortical white matter. There is mild susceptibility effect within the cerebral aqueduct suggestive of blood products. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are unremarkable. SPINE: There is patchy bone marrow signal throughout the cervical and thoracic spine without T2 hyperintense on the STIR sequences to suggest edema. A single sagittal T1 weighted lumbar spine sequence was performed revealing two intrathecal masses that measure approximately 6 x 9 mm at the L1 level and 14 x 15 mm at the L2-L3 level. The vertebral body heights are preserved. The spinal cord displays normal signal.There are mild degenerative changes of the cervical spine with multilevel disc desiccation as well as minimal grade 1 retrolisthesis of C5 on C6 where left-sided uncovertebral arthropathy results in moderate left neural foramen stenosis. There are mild degenerative changes of the thoracic spine with multilevel disc desiccation, loss of disc height, and endplate degenerative as well as a small left paracentral disk extrusion at T6-T7 that indents the thecal sac and the left aspect of the spinal cord without significant spinal canal stenosis. There is also a smaller left paracentral disc protrusion at T7-T8 without spinal canal or neural foramen stenosis. There is a nonspecific patchy focus of high attenuation within the left lung apex.
1.This exam is limited due to lack of contrast as well as incomplete spinal imaging due to the patient terminating the exam prior to completion.2.Postoperative findings related to occipital craniotomy and right frontal approach ventriculostomy catheter placement without hydrocephalus.3.Four foci of signal abnormality within the brain are nonspecific but suspicious for metastases although one demonstrates significant diffusion restriction and could represent a small acute infarct.4.No evidence for spinal cord or conus compression.5.Two intrathecal masses at the L1 and L2-L3 levels are suggestive of metastases, although other mass lesions remain in the differential.6.Heterogeneous bone marrow signal is nonspecific without contrast although may represent treatment-related changes.