 There remains a T1 isointense, T2 hyperintense minimally expansile intramedullary lesion within the cervical cord extending from the lower level of C2 to C4. The lesion is largest within the midportion measuring 9 x 6 mm in the AP and transverse dimensions (series 11, image 18), compared to 7 x 5 previously, suggesting that the lesion may be minimally larger. The lesion is unchanged in the craniocaudal dimension where it measures 22 mm (series 6, image 7). There has been interval recurrence of the associated enhancement which had seemingly resolved on the prior exam. On the axial images, the enhancement is not as discrete as it was on the first examination, but on the sagittal images, the enhancement is at least as conspicuous as on the first study. No other areas of enhancement are noted within the spinal cord. The cervical spine is in normal alignment, with a normal cervical lordosis. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. There is developmental narrowing of the cervical spine and possible thickening of the posterior longitudinal ligament through much of the cervical spine.C2-C3: Shallow disc protrusion without spinal canal stenosis or neuroforaminal narrowing. C3-C4: Posterior disc-osteophyte complex with mild to moderate spinal canal stenosis. Mild bilateral facet hypertrophy and neuroforaminal narrowing.C4-C5: Posterior disc bulge with mild spinal canal stenosis and a superimposed left paracentral disc protrusion. Mild to moderate left neuroforaminal narrowing.C5-C6: Mild developmental spinal canal narrowing and mild right neuroforaminal narrowing due to uncovertebral hypertrophy.C6-C7: Left paracentral disc protrusion with mild left neuroforaminal narrowing. Two oval left thyroid T2 hyperintense lesions are noted, the largest measures 8 x 14 mm. If clinically warranted, further evaluation with ultrasound may be considered along with correlation with laboratory values.
1. There has been interval return of enhancement of the intramedullary lesion extending from C4 to C6. There may also be a subtle increase in the size of the signal abnormality within the cord. The recurrence of these findings may reflect changes in steroid dosing. The differential diagnosis continues to include demyelination, inflammation including granulomatous disease, potentially lymphoma, and less likely primary cord tumor.2. Unchanged, developmentally narrowed cervical spinal canal with mild to moderate multilevel cervical spondylosis. 