History of multiple sclerosis presenting with bilateral numbness and weakness. Bowel incontinence. Rule out transverse myelitis. The examination is limited, partly by patient motion.Cervical spine:The peripheral left-sided cord T2-hyperintense lesion at C2-C3 is unchanged and remains non-enhancing. A larger lesion with more pronounced volume loss at C7 level is also unchanged and non-enhancing. A more centrally located left-sided lesion at the C3-C4 level is slightly more pronounced than the previous examination with more volume loss but it remains non-enhancing. Apparent contrast enhancement superimposed on the ventral spinal cord at the lower C5 level on sagittal imaging does not correlate with definite enhancement on axial imaging and is likely artifactual. The marrow is heterogeneous but without suspicious focal lesion. There is straightening of the cervical spine. There is preservation of the vertebral body heights. Multilevel degenerative disease has slightly progressed at the C6-C7 level where a central disc-osteophyte complex mildly to moderately narrows the spinal canal and indents the ventral aspect of the spinal cord. Similar degenerative disease at C4-C5 has not significantly changed since the previous examination. The cervical carotid arteries course medially in the retropharyngeal space.Thoracic spine:Assessment of the upper thoracic spinal cord is limited by artifact. A small T2-hyperintense non-enhancing lesion without involving the posterior spinal cord at T11 was present previously though is now more conspicuous but this may relate to technical differences between the examinations. Other cord lesions are probably present but the suboptimal nature of the examination does not allow for accurate or definitive assessment. There is no definite contrast-enhancing thoracic spinal cord lesion. There is a small but new right paracentral disc protrusion at T11-T12 but no significant spinal canal or neuroforaminal stenosis. There is no significant degenerative disease at the other levels. The marrow is heterogeneous but without suspicious focal lesion. There is preservation of the vertebral body heights and alignment is anatomic.Small pleural effusions are present.Lumbar spine:The conus medullaris is normal in signal and morphology. There is no abnormal intrathecal contrast enhancement.There is 3 mm of degenerative anterior subluxation of L4 relative to L5. The vertebral body heights are preserved. Marrow signal is mildly heterogeneous but without suspicious focal lesions. There is multilevel facet arthropathy with effusions and inflammatory contrast enhancement, most pronounced and L2-L3. L1-L2 disc is preserved while the other lumbar discs show desiccation and mild bulges. The spinal canal is preserved but there is multilevel neural foraminal stenosis as described below.The uterus is enlarged with multiple T2-hypointense mural masses, compatible with calcified leiomyomata. The largest of the lesions measures up to 9.3 cm. Multiple T2-hyperintense, T1-hypointense renal lesions are not completely characterized but were present on a previous CT scan from April 20, 2015.L1-L2: Mild disc bulge and facet arthropathy but no significant spinal canal or neuroforaminal stenosis.L2-L3: Mild disc bulge causing mild mass-effect on the subarticular recessrd. There is moderate facet arthropathy and ligament thickening as well as mild bilateral neuroforaminal stenosis. There is no significant central spinal canal stenosis.L3-L4: Disc bulge along with moderate facet arthropathy causes mild narrowing of both subarticular recesses and both neural foramina. There is no significant central spinal canal stenosis.L4-L5: The disc bulge/uncovering associated with the anterior subluxation and bilateral facet arthropathy and ligament flavum thickening resulting in left subarticular recess stenosis in addition to mild-to-moderate bilateral neural foraminal stenoses but no significant central spinal stenosis.L5-S1: Disc bulge with associated left foraminal protrusion as well as bilateral mild-to-moderate facet arthropathy result in mild stenosis of the left subarticular recess and moderate-to-severe stenosis of the left neural foramen.
1.The examination is significantly limited, in part by patient motion.2.It is difficult to accurately compare the current and the previous examinations given different imaging parameters. There is increased conspicuity of the spinal cord lesion at C3-C4 and at T11 while the other cervical and thoracic spinal cord lesions remain grossly unchanged. There is no definite abnormal contrast enhancement in the spinal cord.3.There has been progression of the degenerative disease at C6-C7 level resulting in mild-to-moderate spinal canal stenosis as described above. A new small right paracentral T11-T12 disc protrusion has developed but causes no significant spinal canal or neuroforaminal stenosis. Multilevel degenerative lumbar spine disease results in no significant spinal canal stenosis but results in subarticular recess and foraminal stenoses as described above, most pronounced at the left L5-S1 neural foramen.4.There are small pleural effusions. There are multiple renal lesions, which are likely cysts and not significantly changed since April 2015 CT scan. Multiple calcified uterine leiomyomata. 