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Name of the Patient : Abc XyzTriplmn / M / 68 yrs.
Referred by : Dr. Abc Xyzk.
Examination : M.R.I. of the Cervical and Dorsal Spines.

CLINICAL PROFILE :

C/O backache, paresthesias to BUE with weakness, pain on movement, fall while walking, pain in the left knee joint and both elbows with burning sensation.

EXAMINATION :

M.R.I. of the cervical and dorsal spine was performed using the following parameters :

4 mm thick T1 Weighted and T2 Weighted sagittal images.

5 mm thick T1 Weighted and Fast Scan (T2 *) axial images.

After administration of contrast, the following parameters were used :

4 mm thick T1 Weighted sagittal, 5 mm thick axial and 3 mm thick T1 Weighted coronal images with fat saturation.

OBSERVATION :

There is anterior wedging of the D1 vertebral body. Hypointense areas on the T1 Weighted images are seen to replace the normal marrow of the D1, D2, D3 and D4 vertebral bodies which are seen to turn heterogeneously hyperintense on the T2 Weighted images. There is breach in the cortical endplates adjacent to the D1-D2 intervertebral disc with its involvement. There is multi lobulated pre and paravertebral soft tissue extension over the D1 to D3-D4 levels which shows intermediate signal intensity on the T1

Weighted images and turns hyperintense on the T2 Weighted images and may represent abscess/granulation tissue. Anterior epidural extension is noted over the D1 to D3 levels with posterior displacement and compression of the spinal cord over these levels which shows a hyperintense signal on the T2 Weighted images which is isointense to the normal cord on the T1 Weighted images and would represent edema/ischemia/myelitis. Encroachment into the D1-D2 and D2-D3 neural foramina bilaterally is noted with encasement of the corresponding exiting nerve roots. The costo vertebral joints bilaterally at the D1-D2 and D2-D3 levels and costo-transverse joints at the D1-D2 and D2-D3 levels on the left are involved by the pathology.

After administration of contrast, there is heterogeneous enhancement of the D1, D2, D3 and D4 vertebral bodies, the D1-D2 intervertebral disc and the visualized pre, paravertebral and epidural lesion.

There are posterior disc herniations with peridiscal osteophytes at the C3-C4, C4-C5, C5-C6 and C6-C7 levels with anterior indentation of the thecal sac.

Mild ligamentum flavum hypertrophy is noted at the C4-C5 and C5-C6 levels.

The facet joints at the C3-C4, C4-C5 and C5-C6 show degenerative changes.

The cervical vertebral bodies show fatty marrow changes. The cervical intervertebral discs show loss of water content.

The cervical spinal cord reveals normal signal intensity.

The atlanto-axial region and the cervico-medullary junction are unremarkable.
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Dorsal Spine :

A small posterior disc herniation with peridiscal osteophytes is noted at the D7-D8 level. The facet joints at the D5-D6, D8-D9, D9-D10 and D10-D11 levels on the right show degenerative changes.

The dorsal intervertebral discs shows loss of water content.

The visualized dorsal spinal cord reveals normal signal intensity.

The conus medullaris terminates at the L1 level.

The lumbar spine was screened with 5 mm thick T1 Weighted sagittal images and which shows forward translation of the L4 vertebra over the L5 vertebra with probable spondylolysis of the L5 vertebra bilaterally. Posterior disc herniations are evident at the L4-L5 and L5-S1 levels.

IMPRESSION :

The MRI features are suggestive of altered signal involving the D1, D2, D3 and D4 vertebral bodies with involvement of the D1-D2 intervertebral disc, suggests osteitis with discitis. Pre, paravertebral and epidural extensions is as described. Altered cord signal over the D1 to D3 levels suggests cord edema/ischemia/myelitis. This most probably is due to granulomatus infective process like tuberculosis. The possibility of a neoplastic process seems less likely.