Female, 58 years old, history of ependymoma, evaluate for progression. Evidence of extensive prior surgery is redemonstrated with laminectomy defects along the mid to lower cervical and upper thoracic spine. From C2 through C6, syringohydromyelia of the cervical cord is again seen similar to the prior examination. From C7 through T1, the cord becomes very thin. At the T2 level, a loculated cystic collection is seen within the cord which was present on the prior examination from the 2013. Subjectively, this cyst appears slightly larger, but when measurements are made and compared, these are fairly similar to the prior exam yielding 10 x 11 mm transaxial and 21 mm craniocaudal. This cyst has, however, increased in size when compared to examinations from 2011 and 2010.Linear enhancement is evident within the center of the syringohydromyelia beginning at C2 and extending down to C7, a finding which is not changed from prior exam. The margins of the loculated cyst at T2, and particularly the inferior margin, also enhance. The degree of enhancement along the inferior margin seems to be more intense than on the prior examination, but this could be due at least in part to technical differences.Below the cyst, syringohydromyelia tapers down to the T5 level. Below T5, the spinal cord is thin but shows no definite abnormal T2 signal intensity. No definite pathologic enhancement is seen elsewhere.The thoracic kyphosis is exaggerated but otherwise spinal alignment is anatomic. Fatty marrow replacement compatible with radiation therapy is seen beginning from the top of the odontoid process down to the T7 level. No worrisome marrow signal abnormality or enhancement is detected.A large disk osteophyte complex is present at C5-6 in the right paracentral and foraminal zones which probably contributes to foraminal narrowing. A smaller disk osteophyte complex is present diffusely at C6-7. A small left paracentral disk protrusion is present at T6-7. A large superiorly directed disk extrusion is seen at T8-9 in the right paracentral zone which mildly indents the spinal cord. Bulky facet hypertrophy is seen at L4-5 and to a lesser degree at L5-S1.The right kidney is atrophic.
1. Syringohydromyelia of the cervical spinal cord extending from C2 through C6 is approximately unchanged relative to the prior examination. Also unchanged is linear enhancement which extends through the middle of this syringohydromyelia. The enhancing tissue may represent residual tumor, granulation or a combination of both.2. The cord becomes very thin between C7 and T1. At T2, there is a loculated cystic component within the cord which, although not convincingly changed relative to the prior examination from 2013, has increased in size from older studies. The margins of this cyst, and particularly the inferior margin, do enhance.3. Fatty marrow replacement compatible with radiation therapy is seen from C2 through T7. Marrow signal is otherwise unremarkable.4. Scattered disk herniations and degenerative findings as above.5. Atrophy of the right kidney.