sb/ke
/8 Date : 00.00.00

Name of the Patient : Abc Xyzta Slmn / F / 35 yrs.
Referred by : Dr. Abc Xyzelwal.
Examination : M.R.I. of the Lumbo-sacral Spine.

CLINICAL PROFILE :

C/O backache with severe pain in the iliac joints, more on the left side since 1 month with irregular motion.

EXAMINATION :

M.R.I of the lumbo-sacral spine was performed using the following parameters :

5 mm thick T1 Weighted and T2 Weighted sagittal images.

5 mm thick T1 Weighted and T2 Weighted axial images.

The dorsal spine was screened with 5 mm thick T1 Weighted and T2 Weighted sagittal images.

The sacro-iliac joints and both hips were screened with 5 mm thick T1 Weighted and STIR coronal images.

OBSERVATION :

There is sacralization of the L5 vertebra.

The visualized lumbar and sacral vertebral bodies shows a diffuse hypointense signal when compared to the normal marrow on the T1 Weighted images and appear heterogeneously hyperintense on the T2 Weighted images. No bone destruction or erosion is noted.

A small posterior disc bulge is noted at the L4-L5 level.

The lumbar intervertebral discs show normal signal intensity. The facet joints and the visualized pre and paravertebral soft tissues are unremarkable.

The conus medullaris terminates at the L1 level and the thecal sac terminates at the S1 level.
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The antero-posterior dimensions of the lumbar canal at the level of the intervertebral discs are as follows :

20.0 mm at L1-L2
19.0 mm at L2-L3
18.0 mm at L3-L4
17.0 mm at L4-L5
11.0 mm at L5-S1.

Screening, T1 Weighted and T2 Weighted sagittal images of the dorsal spine reveal similar signal intensity changes in the dorsal vertebral bodies as visualized in the lumbo-sacral vertebrae. The dorsal spinal cord shows normal signal. There is no cord compression. Incidentally noted is a soft tissue density lesion in the right hilum which is probably an enlarged right hilar lymphnode.

Screening images of the pelvis and both hips reveal diffuse hypointense signal on the T1 Weighted images involving the pelvic bones and the neck and the proximal shaft of the femora on either side. This signal appears hyperintense on the T2 Weighted images.

IMPRESSION :

Diffuse altered signal involving the visualized dorsal and lumbo-sacral vertebrae, the pelvic bones and neck and proximal shafts of the femora on either side as described is not specific for a single etiology.

The differential diagnosis would include,

1. A reticulo-endothelial disorder.

2. Multiple metastases.

3. Multifocal tuberculosis.

4. Remote possibility of a metabolic bone disease.

An enlarged right hilar lymphnode is noted.

A bone biopsy would be worthwhile.