MRI CERVICAL SPINE W WO CONTRAST, MRI THORACIC SPINE W WO CONTRAST 11/6/2023 7:45 AM
1. Postoperative changes within the cervical spine, as described.
2. Stable expansile distortion and signal abnormality within the cervical cord compatible with sequela of prior remote insult with additional central canal adhesions and/or cord tethering with syrinx formation and/or presyrinx edema.
3. Diffuse mild volume loss of the remainder the cervical and thoracic cord.
4. Multilevel degenerative changes within the cervical spine.
5. Stable cystic lesion in the region of the gastroesophageal junction.
INDICATIONS: worsening paresthesias, history of Tetraplegia. C2-C4 ACDF and laminectomies prior as well as syringosubarachnoid shunt placement in 2022; plus cisternogram
TECHNIQUE: MRI cervical and thoracic spine with and without contrast. 22 mL MultiHance
COMPARISON: MRI cervical and thoracic spine 831/22
MRI cervical spine: MRI of the cervical spine was performed.
Examination of the cervical cord again demonstrates expansile cord signal abnormality centered at the C3-4 level. This presumably represents sequelae of prior cord injury with central canal adhesion, cord tethering, and focal syrinx formation and/or presyrinx edema.
There is volume loss throughout the remainder of the visualized cervical and upper thoracic cord.
No pathologic leptomeningeal or cord parenchymal enhancement is noted throughout the cervical canal.
Anterior stabilization plate and screws are noted at the C2-3 level. Laminectomy defect is noted from the C2-C4 levels. Postoperative changes are noted within the posterior soft tissues in this region.
Again noted is multilevel degenerative disc disease of the cervical spine with concentric disc bulges and spondylitic ridging without significant central canal narrowing or significant direct cord impingement although mild cord abutment is noted at a few levels.
There is multilevel uncovertebral joint and facet arthropathy of the cervical spine with multilevel neural foraminal narrowing most notably on the left at the C3-4 level.
There are additional fluid collections within the left aspect of the central canal extending into the neural foramina at the C4-5 and C5-C6 levels potentially representing small pseudomeningoceles in the setting of nerve root avulsion although other etiology including other chronic fluid collection the setting of prior trauma is also possible.
More complex but similar signal abnormality is also noted along the left extending into the left neural foramen at the C3-4 level as well.
Mucosal thickening and partial opacification of the sphenoid sinus at the edge of the field-of-view is noted.
There is absent signal void within the left vertebral artery presumably on the basis of chronic occlusion or slow flow.
When compared the prior examination, the appearance of the cervical cord and cervical spine remains largely stable when given differences in technique.
MRI thoracic spine: MRI of the thoracic spine was performed.
MRI of the thoracic spine was performed.
Examination of the thoracic cord demonstrates mild diffuse cord volume loss for age. No evidence of pathologic cord signal abnormality, expansion, or enhancement is noted. There is no evidence of pathologic leptomeningeal enhancement within the central thoracic canal.
The bone marrow signal intensity of the thoracic spine is within normal limits.
Multilevel very mild degenerative disc disease is noted within the thoracic spine.
Note is made of a stable cystic lesion or region along the dorsal aspect of the left hepatic lobe and near the gastroesophageal junction