Comparison is made to an outside MRI and the previous CT from this hospital.
Recurrent chordoma is documented-with markedly hyperintense signal on T2 weighted scans, best demonstrated on the fat saturated axial and coronal T2 images, with tumour in the midline and on the right 6.7 x 3.2 cm, in continuity with multiple contiguous nodules in both ischio rectal fossae, on the left with displacement of the levator ani complex superiorly, and with a high suspicion for tumour invasion across this fascial plane. More inferiorly from the ischio rectal fossa, tracking between the gluteus maximus and medius muscles, is a tongue of tumour that reaches to the subcutaneous tissues laterally on the buttock, 1.3 cm wide, and 12 cm long (extending along a surgical plane? ). Tumour extends into the central and right side of the sacrum - both bone and canal.
Enhancement is moderate. Tumour does not reach to the lumbar spine, and there is no involvlement of the bony pelvis outside the sacrum.
Conclusion: Local tumour spread demonstrated, in gluteal region, perineum, sacrum, ischiorectal fossa, and likely spread through the left levator ani abutting the rectum.