sb/hs/nl/rg.
Date : 00.00.00

Name of the Patient : Abc Xyzti Gurchlmn / F / 30 yrs.
Referred by : Dr. Abc Xyzwhale.
Examination : M.R.I. of the Lumbo-sacral Spine.

CLINICAL PROFILE :

C/O backache with pain radiating to BLE with paresthesias and weakness of BLE since 1 year.

EXAMINATION :

M.R.I of the dorso-lumbar spine was performed using the following parameters :

5 mm thick T1 Weighted and T2 Weighted sagittal images.

7 mm thick T1 Weighted and T2 Weighted axial images.

OBSERVATION :

The D8 and L3 vertebral bodies are as marked on the film.

There is central and anterior wedging of the D10, D11, D12 and L1 vertebral bodies with a kyphus at these levels. The D7 to L3 vertebral bodies appear hypointense on the T1 Weighted images and remain predominantly hypointense on the T2 Weighted images with focal hyperintense areas within. The D10-D11, D12-L1 and L1-L2 intervertebral discs also seem to be involved by the pathology with irregularity of the adjacent cortical endplates.

There is an intermediate signal intensity mass lesion on the T1 Weighted images in the anterior epidural space over D10 to L1 vertebral levels. This lesion appears heterogeneously hyperintense on the T2 Weighted images. Part of the lesion inferiorly, seems to be calcified and appears hypointense on all the pulse sequences. There is resultant cord compression over the D10 to L1 vertebral levels. The lower dorsal spinal cord over these levels shows a hyperintense signal on the T2 Weighted images suggesting cord edema/ischemia/myelomalacia.
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There is also prevertebral and paravertebral soft tissue lesion (of similar signal characteristics as the anterior epidural lesion) extending over the D8 to L2 vertebral levels. Multiple septae are noted within this lesion. A fairly large, left paravertebral lesion is noted extending from the L1 vertebral level, inferiorly, along the left psoas muscle, upto the pelvic region.

The rest of the visualized dorso-lumbar vertebral bodies and the remaining intervertebral discs reveal normal signal intensity. The facet joints at the D10-D11 level appears slightly hypertrophied.

The conus medullaris terminates at the L1 level.

IMPRESSION :

Altered signal of the D7 to L3 vertebrae with central and anterior wedging of the D10, D11, D12 and L1 vertebral bodies and the D10-D11, D12-L1 and L1-L2 intervertebral discs as described, most likely represents osteitis with discitis, probably tuberculous in etiology.

Soft tissue mass lesion in the anterior epidural space over D10 to L1 vertebral levels, in the pre and paravertebral soft tissues over the D8 to L2 vertebral levels and along the left psoas muscle as described would represent granulation tissue/abscess. There is cord compression over the D10 to L1 vertebral levels with cord signal alteration suggesting cord edema/ischemia/myelomalacia.

The possibility of this lesion representing a neoplasm seems less likely.