Clinical question: Assess for spinal tumor recurrence. Signs and symptoms: Back pain and headache. Pre- and post enhanced cervical MRI:Examination demonstrates extensive post operative changes of spinal fusion. There is evidence of mild central spinal stenosis at C4-C5 level secondary to mass effect by posterior element at this level without evidence of tumor. Signal intensity and caliber of cervical cord remains within normal and without abnormal enhancement.There is a dural based mass with T2 hypointense and T1 isointense signal change with uniform diffuse enhancement along the clivus as well as noted on prior brain MRI exam without appreciable change.There is no detectable enhancing mass in the cervical region.Pre- and post enhanced thoracic MRI:There is a shallow dorsal dural based T2 hypointense and T1 isointense lesion along the dorsal aspect of the spinal canal extending from T1 inferiorly to approximately T4 level which could represent residual tumor or scarring from extensive surgery posteriorly. Extensive post operative expected enhancement of the posterior soft tissues of the neck at the level of surgery extending from lower cervical through upper thoracic which could obscure enhancement of dorsal dural based mass. This finding measures approximately 6 mm in maximum thickness which is at T2 level and results in partially effacement of the dorsal subarachnoid space at T2 level however without evidence of mass effect or displacement of the cord or significant central spinal stenosis. There are no prior exams for comparison, however if such studies are available and provided to radiology department and an addendum to this report will be submitted after comparison.There is exaggerated kyphosis of upper thoracic spine likely secondary to extensive postop changes. There is however no spinal stenosis or any additional detectable soft tissue abnormality or enhancement. No spinal stenosis at any level and normal signal intensity and caliber of thoracic cord.Pre- and post enhanced lumbar MRI:There is normal signal intensity and alignment of vertebral column.There is no detectable mass or abnormal signal intensity of conus or the cauda equina. There is extensive hypertrophic changes of the articulating facet at L4-L5 on the left with expected enhancement of the facet complex and minimally of the left ligamentum flavum. Unremarkable exam otherwise.
1.Pre- and post enhanced MRI of cervical spine demonstrate no evidence of a mass or abnormal enhancement are noted than expected enhancement of soft tissues of the lower cervical spine secondary to extensive prior surgery. This is study however partially visualizes previously known dural/epidural enhancing mass along the clivus similar to prior brain MRI exam from 5-21-15.2.Pre- and post enhanced MRI of thoracic spine demonstrate exaggerated kyphosis due to multilevel upper thoracic laminectomy for removal of tumor. Shallow dural base T2 hyperintense lesion along the dorsal aspect of thecal sac extending from T1 to T4 and with maximum thickness at T2 level of 6 mm which could represent residual tumor or postoperative scarring. No prior exams for comparison however if such studies are available and provided to radiology department and an addendum to this report will be submitted after review/comparison. No additional foci of abnormal signal or enhancement to suggest tumor. Normal signal intensity and caliber of the cord without enhancement or central spinal stenosis at any level.3.Pre and postcontrast enhanced MRI of lumbar spine demonstrate no evidence of tumor. There is however expected enhancement of severely degenerated left articulating facet and minimally of the left ligamentum flavum as detailed above. There is no evidence of spinal canal or neural foraminal compromise/stenosis at any level.