sb/ke/nl/rg.
Date : 00.00.00

Name of the Patient : Abc Xyzed Almn / M / 22 yrs.
Referred by : Dr. Abc Xyzrekh.
Examination : M.R.I. of the Lumbo-sacral Spine.

CLINICAL PROFILE :

C/O backache since 2 years with numbness in the lower lumbar region.
H/O fall 2 1/2 years back.

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.

6 mm thick T1 Weighted and T2 Weighted axial images.

The dorsal spine was screened with 4 mm thick T1 Weighted sagittal images.

OBSERVATION :

The L3 vertebral body is as marked on the film.

There is Grade I spondylolisthesis of the L5 over the S1 vertebra with probable spondylolysis at L5, bilaterally.

There are ill-defined, hyperintense areas on the T2 Weighted images in the L4, L5 and S1 vertebral bodies. These areas appear hypointense on the T1 Weighted images. The L5-S1 intervertebral disc is also reduced in height and appears hyperintense on the T2 Weighted images. Similar signal intensity changes are noted in the D12 and L1 vertebral bodies and the D12-L1 intervertebral disc. The D12 and L1 vertebral bodies are slightly wedged, anteriorly. Altered signal is also noted in the sacral ala on the right and in the left iliac bone adjacent to the left sacro-iliac joint. Involvement of the left sacro-iliac joint per se is noted.
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There is an intermediate signal intensity soft tissue lesion on the T1 Weighted images in the prevertebral and paravertebral soft tissues at the L5 and S1 vertebral levels and in the anterior epidural space over the L4 to S1 vertebral levels. This lesion also appears hyperintense on the T2 Weighted images. Encasement of the L5 nerve roots in the neural foramen bilaterally is noted.

At the D12 and L1 vertebral levels, soft tissue lesion is noted in the anterior epidural space and in the right paravertebral region involving the right psoas muscle. Indentation on the lower dorsal spinal cord at the D12/L1 levels is also noted. The lower dorsal spinal cord at these levels show a subtle hyperintense signal on the T2 Weighted images which suggest cord edema/ischemia.

The rest of the lumbar vertebral bodies and the remaining intervertebral discs reveal normal signal intensity. The facet joints are unremarkable.

The conus medullaris terminates at the L1 level and the thecal sac terminates at the S1 level.

IMPRESSION :

Altered signal in the D12, L1, L4, L5 and S1 vertebral bodies and the D12-L1 and L5-S1 intervertebral discs most likely suggest osteitis with discitis, probably tuberculous in etiology. Paravertebral and anterior epidural soft tissue lesion at these levels would represent granulation/abscess. There is mild cord compression at the D12 and L1 levels with subtle cord signal alteration suggesting cord edema/ischemia.

The possibility of these lesions representing neoplasm seems less likely.

Altered signal is also noted in the ala of the sacrum on the right, left iliac bone adjacent to the left sacro-iliac joint and the left sacro-iliac joint per se.