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Date : 00.00.00

Name of the Patient : Abc Xyzbhai R. Plmn / M / 75 yrs.
Referred by : Dr. Abc Xyzhah.
Examination : M.R.I. of the Lumbo-sacral Spine & Sacro-iliac Joints.

CLINICAL PROFILE :

C/O backache radiating to BLE since 1 month which has increased since 1 week.

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 sacro-iliac joint was scanned with 5 mm thick T1 Weighted axial images and 5 mm thick STIR coronal images.

OBSERVATION :

There is collapse of the L1 vertebral body. There is replacement of the normal marrow of L1 by the hypointense areas on the T1 Weighted images which is seen to turn heterogenously hyperintense on the T2 Weighted images. There is slight bulge of the vertebral body with pre and paravertebral soft tissues with breach in the posterior and superior cortex.. A small anterior epidural extension is also noted.

Hypointense areas are also noted within the L3, L4, L5, S1, S2 and the S4 vertebral bodies on the T1 Weighted images. Similar areas are seen in the right pedicle and the transverse process of the D5 vertebra, both the sacral ala and the iliac bones. Subtle hyperintense signal is noted on the STIR images in the left gluteal muscle with break in the cortex of the left iliac bone.

Small posterior disc bulges are seen at the L4-L5 and L5-S1 levels.

The prostate appears to be enlarged.

A cystic area is seen within the left kidney ? cortical cyst.
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The conus medullaris terminates at the L1 level and the thecal sac terminates at the S1 level.

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

18.0 mm at L1-L2

19.0 mm at L2-L3

16.0 mm at L3-L4

13.0 mm at L4-L5

13.0 mm at L5-S1.

The cervico-dorsal spine was screened with 5 mm thick T1 Weighted sagittal images
which shows slight degenerative changes in the cervical region and Schmorls nodes at the D6-D7 and D7-D8 levels. A hemangioma is seen in the D7 vertebral body.

IMPRESSION :

The MRI features are suggestive of altered signal of the L1, L3, L4, L5, S1, S2 and S4 vertebral bodies with extensions as described. There is also involvement of the
right pedicle and the transverse process of the D5 vertebra, both the sacral ala and the iliac bones and left gluteal muscle by the pathology. These most likely represent metastasis.

In view of the enlarged prostate, a prostatic carcinoma with metastasis may be considered as a likely possibility.

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