Help Interpreting Cervical MRI

[davincidanes]

Can anyone help me make sense of this in less technical terms?  Do these findings correlate with lower body numbness and mobility problems?  I have numbness from the hip level down equally on both sides, as well as a handful of other issues. Note that I've had Lhermittes  for several years, since 1996.  Surgery for cervical stenosis was done in 1997 to decompress my spinal cord, but the Lhermittes has never gone away and has gotten worse in recent years.  The numbness and gait issues have been with me for about a year. Thank you.

Technique: Multi-sequence sagittal and axial MR imaging of the cervical spine is performed before and following the administration of 13 ml MultiHance intravenous gadolinium contrast.

Comparison:  No prior MRI of the cervical spine.  Cervical spine radiographs 10/26/2013.

Findings: There has been prior posterior element resection from C3-C7.  There is no significant marrow signal abnormality.

There is abnormal signal in the cervical cord laterally on the left at this C4 level with increased T2 signal and eight 2 x 3 mm ovoid peripheral focus of enhancement. Posteriorly withing the cord at the C5 level there is a 3 mm rounded focus on increased T2 signal which demonstrates some punctate areas of peripheral nodular enhancement.

There is questionably mild expansion of the cord at this level.  There is low-level heterogeneous increased T2 signal in the cord from the C4-C5, possibly some mild edema or myelomalacia change.

At C2-C3 there is mild disc osteophyte complex bulge without central canal stenosis or foraminal narrowing.  There is evidence of focal annular tear.

C3-C4: There is moderate diffuse circumferential disc osteophyte complex bulge with moderate left uncovertebral spurring resulting in moderate left forminal stenosis.  There is no central canal stenosis.

C4-C5: There is moderate diffuse disc osteophyte complex bulge with bilateral uncovertebral spurring.  There is moderate bilateral forminal stenosis.  No central canal stenosis.

C5-C6: There is severe right uncovertebral spurring resulting in severe right foraminal stenosis.  There is no central canal stenosis or significant left foraminal narrowing.

C6-C7:  There is minimal posterior disc bulge without central canal stenosis or foraminal narrowing.  Moderate hypertrophic degenerative facet changes are present bilaterally.

Impression:  

1. Two foci of abnormal signal and enhancement within the cervical cord at C4 and C5. There is questionably some mild expansion of the cord at the C5 level and mild cord edema versus myelomacia change.  Concievably the findings could be on the basis of prior surgery, but the enhancement would not be expected given remote surgical history in 1997.

Differential considerations include multiple sclerosis with enhancing active plaques, an atypical appearance of spinal cord neoplasm such as astrocytoma or less likely metastatic disease.

Recommend MRI of the brain without and with contrast.

2. Multilevel degenerative disc disease and uncovertebral spurring throughout the cervical spine resulting in foraminal stenosis bilaterally, greatest at C5-6 on the right, correlate for clinical signs of impingement.

3. Postsurgical changes with resection of the posterior elements from C3-C7.

Here is the Brain MRI report.

Technique: Sagittal axial and coronal images were performed.  Post-gadolinium images were also performed.  We injected 12 ml of MultiHance intravenously.

Findings:  The ventricles are normal in size and shape and position.  The diffusion-weighted images show no recent infarcts.  FLAIR sequences and T2-weighted sequences show a few scattered focal areas of increased signal involving the periventricular white matter.

For example, there is a 5 mm lesion within the right frontal loge on image #15 series 6.  There are additional bilateral lesions but none of these lesions enhance with contrast.

Apparently, there were two focal areas of enhancement within the cervical cord on the MRI of the cervical spine dated 08/04/2014. There were no extracerebral fluid collections and no mass or mass effect.

Impression:  1.  There are a few scattered focal areas of increased signal withing the periventricular white matter which are nonspecific but would support the diagnosis of multible sclerosis.  However, there was no contrast enhancement.  No evidence of a mass.  The remainder of the study was within normal limits.

Any help with this is greatly appreciated as I'm preparing for the MS Neuro Specialist appointment scheduled for next month.

Thanks.  ~Linda

[jensequitur]

Yeah, they used to say that the lesions would enhance around the edges when there was a new relapse. They would see a white ring around an already existing lesion. However, I've had relapses without enhancing lesions. That means either they didn't look at the area that was enhancing, or the lesions didn't enhance!

I felt so crummy the first few years after the diagnosis that it was hard to say if I was in the middle of a relapse, or just feeling like crud.

[davincidanes]

Thanks all.  Yes, the new symptoms with the numbness, gait and balance issues are all recent... starting about a year ago and getting progressively worse. However, my general Neuro had me get SoluMedrol Infusions in November to see if I can get some relief before I could get in to see the MS Specialist,  and the symptoms have slightly improved.  I realize that my neck history makes matters more difficult.  
When I get a few minutes, and can remember where I put them, I'm going to try to find my MRI reports from 1996-1997. They may or may not be helpful.

Thanks again.  :)  ~Linda

[essdipity]

Have to disagree with Jen somewhat. Not having enhancing lesions in your brain doesn't affect relapse one way or another. This is because old lesions, which will not enhance, can cause new relapses.

Of course, you do have enhancing lesions in your c-spine, but I'm not sure whether you're having new symptoms. In any case, symptoms and lesions of any age don't necessarily correlate. That's a good thing. There's lots of CNS real estate where lesions can occur, but if they all caused problems most of us would be considerably more debilitated than we are.

Your previous neck issues and surgery may make diagnosis even more difficult. Good luck.

ess

[kwarendorf]

Hi -

Not only did she list MS as a possible cause of the two c-spine lesions, but note that they enhanced. This means that they "Lit Up" in the presence of the contrast agent. Enhancing lesions have been active within the past 30-40 days.

Kyle

[davincidanes]

Thank you very much.

[jensequitur]

Your radiologist reported that there were two foci of abnormal signal and enhancement. What this means is that he found two white spots in the cord at C4 and C5. You can look on Google images to find the location in your neck. It will certainly cause a L'Hermittes reaction, and lower body symptoms. The lesions are on the left and the back of the cord.

Your brain MRI had lesion activity as well - the 'scattered focal areas' - but there was no enhancement, which means you're not actively having a relapse.