ke/bv/rg/nl
Date : 00.00.00

Name of the Patient : Abc XyzDalmn / M / 87 yrs.
Referred by : Dr. Abc Xyzcha.
Examination : M.R.I. of the Lumbo-sacral Spine.

CLINICAL PROFILE :

C/O backache since 6 months radiating to BLE with paresthesias (left more than right) since 1 month.

EXAMINATION :

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

5 mm thick T1 Weighted sagittal images.
5 mm thick T1 Weighted axial images.

The pelvis and the sacro-iliac joints were studied with the help of 5 mm thick T1 Weighted and STIR coronal images and 7 mm thick T1 Weighted and T2 Weighted axial images.

FEW IMAGES SHOW PATIENT MOTION.

OBSERVATION :

There is replacement of the normal marrow of the sacral ala bilaterally by hypointense areas on the T1 Weighted images. These are seen to turn hyperintense on the T2 Weighted and STIR images. Few areas are noted within the sacrum which are nearly isointense to CSF on the T1 Weighted images and would represent necrosis. Similar well-circumscribed areas are also noted in the iliac bones bilaterally. There is slight involvement of the adjacent soft tissues.

Well-circumscribed hypointense areas are noted on the T1 Weighted images within the L5 and L1 vertebral bodies and the head of the femur on the right side. There is suspicious involvement of the neck of the left femur and the D4 vertebral body. These are seen to turn hyperintense on the T2 Weighted and STIR images.
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There is scoliosis of the lumbar spine with convexity to the left. Left lateral subluxation of the L2 over the L3 is noted. There is retroplacement of the L2 over the L3 vertebra.

Diffuse posterior disc bulges with peridiscal osteophytes are noted at the L5-S1 level. Severe facetal hypertrophic arthropathy is seen at this level with ligamentum flavum hypertrophy and resultant tight canal.

Posterior peridiscal osteophytes are seen at the L2-L3, L3-L4 and the L4-L5 levels with bilateral neural foraminal narrowing. Facetal arthropathy is also noted. There is ligamentum flavum hypertrophy at the L4-L5 level.

Large anterior peridiscal osteophytes are seen in the lower lumbar region.

Diffuse fatty changes are seen in the lumbar vertebral bodies.

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

The conus medullaris terminates at the L1 level.

The antero-posterior dimensions of the lumbar canal at the level of the intervertebral discs are as follows :

21.0 mm at L1-L2
18.0 mm at L2-L3
17.0 mm at L3-L4
15.0 mm at L4-L5
12.0 mm at L5-S1.


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The dorsal spine was screened with the help of 5 mm thick T1 Weighted sagittal images and shows mild degenerative changes with focal fatty changes. A hemangioma with fatty content is noted in the D10 vertebra. There is slight wedging of the D11 vertebral body with focal fatty changes probably osteoporosis. Suspicious involvement of D4 is noted.

IMPRESSION :

The MRI features are suggestive of :

1. Altered signal in the sacrum, iliac bones, head of the right femur, neck of the left femur and the L5 and L1 vertebral bodies may represent metastasis.

The possibility of this being an infective process is considered unlikely.

2. Diffuse posterior disc bulges with peridiscal osteophytes at the L5-S1 level with severe facetal hypertrophic arthropathy, ligamentum flavum hypertrophy and resultant tight canal at this level.