Radiology Report (12/4/2006 – Sensory Problems with Palms)
This is my MRI radiology report following my scan on December 3, 2006. I had this scan due to a loss of sensation in both palms of my hands. The spine was done because due to the problem being symetrical he thought it was a definately a spinal lesion around C6-7.
PATIENT: SMITH, ERIK
MRI OF THE BRAIN WITHOUT AND WITH CONTRAST
TECHNIQUE: Sagittal T1. Axial FLAIR. Axial T2. Diffusion weighted. Axial T1. Postcontrast axial T1.
FINDINGS: Diffusion-weighted imaging is negative for acute infarction.
As noted previously, there are numerous foci of increased T2/FLAIR signal in the cerebral white matter bilaterally. Several new lesions have developed since the prior study. In addition, there has also been progression of prior disease.
At the junction between the corona radiata and centrum semiovale (image 49, series 4), several additional lesions are now present as compared with the prior study of 5/5/05. Slightly further inferiorly, on image 50, series 4, several additional lesions are also seen in the peritrigonal regions and corona radiata both on the right and on the left. Similarly, more lesions are seen still further inferiorly on image 51.
On image 52 and 53, there are several more lesions now apparent around the right ventricular trigone and occipital horn.
A new lesion is now seen to involve the right medullary pyramid and olive (image 59, and 60, series 4). Maximum dimension of this new lesion is approximately 6 mm.
No definite pathologic enhancement is seen after contrast administration (allowing for phase-encoding artifact on several images). However, clearly the lesions are new since the prior examination.
There is no midline shift or hydrocephalus. There is no recent infarct or hemorrhage.
The mastoid and middle ear cavities are normal. The paranasal sinuses are unimpressive.
- Interval progression of disease since the prior study of 5/5/05. Several new lesions have emerged since the prior examination as discussed above. These are particularly prominent with respect to the levels of the corona radiata, corona radiata/centrum semiovale junction, right peritrigonal region, and right medullary pyramid and olive.
- No obvious pathologic enhancement is present on the current examination.
- There is no midline shift or hydrocephalus.
PATIENT: SMITH, ERIK
MRI OF THE CERVICAL SPINE WITHOUT AND WITH CONTRAST:
TECHNIQUE: Sagittal T1. Sagittal T2. Sagittal STIR. Postcontrast sagittal T1. Postcontrast axial T1. Axial T2-weighted gradient-echo, both 3D and 2D.
COMPARISON: No prior studies available for comparison at the time of dictation. [They should have sent the images from my 5/16/2003 scan]
FINDINGS: Several foci of abnormal cord signal are identified compatible with plaques of demyelination. Note that no axial T2 fast spin echo sequence is available for assessment. It is recommended that the patient be requested to return to the Department for this sequence to provide a more comprehensive assessment of the cervical cord parenchyma (the sagittal STIR sequence is degraded by artifact and the gradient-echo axials are not considered optimal for cord parenchyma evaluation).
At the level of C2, a well-circumscribed plaque is identified (image 199 and image 270). This measures approximately 12 mm craniocaudal x 4 mm anteroposterior x 5.3 mm transverse. Slightly more cephalad, there appears to be a possible second lesion present at the C1-2 level (image 270 and image 199). This is a small lesion measuring approximately 6 mm craniocaudal x 2 mm anteroposterior. This second slightly higher focus is not covered on the axial sequences.
No definite lesion is identified at the level of C3.
At the level of C4, a possible lesion is present. This is not clearly identified on the sagittal T2 sequence, however, it is suggested on the sagittal STIR sequence. Also on the gradient-echo lesions, a lesion does appear to be present here in the midline and to the right of midline.
At the level of C5, no definite lesion is identified. The apparent lesion here on the STIR sequence may be artifactual. There does appear to be some artifact overlying the gradient-echo axials as well, These two levels could be clarified to much greater advantage by means of an axial T2-weighted fast spin echo sequence.
At the level of C6, no definite lesion is identified and the apparent lesion seen on the STIR sequence is felt to be most likely artifactual. Note that that there is a fairly prominent protrusion at the C6-7 level which will be discussed further below.
At the level of C7, no definite cord lesion is identified.
The central canal at C6-7 is moderately stenotic at approximately 7.3 mm. This is due to a brood-based bulge of approximately 3 mm which is accentuated in the left paramedian region. The central canal elsewhere appears adequate. The foramina appear adequate throughout.
There is no loss of vertebral body height or alignment. There is no edema in the vertebral: bodies, posterior elements or paravertebral soft tissues.
- Several foci of definite and possible increased T2/STIR signal in the cord parenchyma as discussed above. Please refer to discussion of individual details as outlined above. Note that some of the lesions are questionable, seen on certain sequences but not on others. Also note that there is no axial T2-weighted fast spin echo sequence which would be very helpful in providing a much more sensitive evaluation of the cord parenchyma. It is recommended that this sequence also be obtained to complete the assessment.
- The above-mentioned foci of abnormal signal are compatible with plaques of demyelination.
- There is no obvious pathologic enhancement in the cord parenchyma after contrast administration.
- There is no significant tonsillar ectopia. There is no compression at the level of the foramen
- Moderate central canal stenosis is present at C6-7 due to a broad-based bulge. The central canal elsewhere is in the adequate range. The foramina appear adequate throughout.