hs/bv/nl/rg.
Date : 00.00.00

Name of the Patient : Abc Xyzkar lmn / M / 67 yrs.
Referred by : Dr. Abc Xyzngsarkar.
Examination : M.R.I. of the Lumbo-sacral Spine.

CLINICAL PROFILE :

C/O low backache with pain radiating to BLE with paresthesias and bladder involvement.

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 4 mm thick T1 Weighted and T2 Weighted sagittal images.

OBSERVATION :

There is evidence of a space-occupying lesion in the posterior epidural space over the L3 to the L5 vertebral levels. This lesion is hyperintense to normal muscle but hypointense to fat on the T2 Weighted images and mildly hyperintense to both on the T2 Weighted images. Also seen is indentation and slight anterior displacement of the thecal sac at these levels.

Hyperintense areas on the T2 Weighted images are seen within the left paraspinal muscles at the L3 and L4 levels with a probable small cystic/necrotic component.

The intrathecal nerve roots from the L4-L5 level upwards are not well-defined. There is loss of the conus-cauda differentiation.


The visualized dorso-lumbo-sacral vertebrae appear more hypointense than normal.

The L3-L4 and L4-L5 facet joints show hypertrophic degenerative changes. Effusion is noted within the L3-L4 and L4-L5 facet joints bilaterally and on the left side at the L5-S1 level.

Small posterior disc herniations are seen to indent the thecal sac and narrow both neural foramina bilaterally at the L3-L4 and L4-L5 levels.

The conus medullaris terminates at the L1 level and the thecal sac terminates at the S2 level.

Screening of the dorsal spine reveals no other feature of note other than marrow signal alteration.

IMPRESSION :

The MRI features are suggestive of a lesion within the posterior epidural space over the L3 to L5 vertebral levels with a component in the left paraspinal soft tissues at the L3 and L4 levels with a probable intradural component as described. The visualized dorso-lumbo-sacral vertebrae also show altered signal intensity (? preponderance of hematopoeitic marrow, ? myeloproliferative disorders).

The differential diagnosis would include :

1. Neoplasia like small cell tumors.

2. Infection like tuberculosis.