Lymphoma, receiving intrathecal chemotherapy. Brain: Again seen is enhancement and mild enlargement involving multiple cranial nerves, particularly the bilateral trigeminal and ocular motor nerves which is stable or slightly decreased since prior. No new parenchymal or meningeal enhancement is seen to suggest tumor progression. There is no intraparenchymal mass or evidence of intracranial mass effect. There is a right transfrontal Ommaya catheter with interval increase in pneumocephalus which may be related to recent catheter manipulation. There is extensive confluent cerebral white matter T2 hyperintensity similar to prior. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is diffuse right maxillary sinus mucosal thickening which is new since prior. Additional partial opacification of the paranasal sinuses similar to prior.Cervical Spine: There is been improvement in previously seen diffuse enhancement and enlargement of multiple bilateral cervical and upper thoracic extraforaminal enhancing nerve roots. Residual enhancement and mild enlargement is most apparent involving the right C5 nerve root as well as the partially imaged thoracic nerve roots. Otherwise, there is no evidence of tumor or abnormal enhancement within the cervical spinal canal. The spinal cord displays normal signal and morphology. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is unchanged mild multilevel degenerative spondylosis, but no significant spinal canal or neural foraminal stenosis. The paravertebral soft tissues are unremarkable.
1. Stable to minimal decrease in enhancement involving multiple cranial nerves compatible with known lymphoma. No intraparenchymal mass or new enhancement to suggest disease progression in the brain. There is relatively more pronounced decrease in enhancement involving the multiple bilateral cervical and upper thoracic nerve roots. These findings suggest disease improvement.2. The no significant change in extensive white matter signal abnormality involving the bilateral cerebral hemispheres likely representing posttreatment change.