Date : 00.00.00
Name of the Patient : Abc Xyzm Klmn / M / 58 yrs.
Referred by : Dr. Abc Xyzdhav.
Examination : M.R.I. of the Lumbo-sacral Spine.
CLINICAL PROFILE :
C/O backache radiating to the RLE since 1 month.
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.
There is a postero-central disc herniation at the L5-S1 level with anterior indentation of the thecal sac and the S1 nerve roots bilaterally. There is inferior migration of the disc fragment which is seen to lie posterior to the S1 vertebral body.
A small posterior disc bulge is seen at the L4-L5 level. This disc shows loss of water content.
There is replacement of the normal marrow of the visualized dorso-lumbar vertebrae by hypointense areas on the T1 Weighted images. These are seen to turn heterogenously hyperintense, (especially the L1, L5 and S1 vertebral bodies) on the T2 Weighted images. The posterior cortex of the L5 and S1 vertebrae appears fuzzy and is breached. Anterior epidural lesion is seen at the L5 and S1 levels.
The facet joints and the visualized pre and paravertebral soft tissues are unremarkable.
- 2 - scan-00001
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 :
19.0 mm at L1-L2
18.0 mm at L2-L3
15.0 mm at L3-L4
14.0 mm at L4-L5
6.0 mm at L5-S1.
The sacro-iliac and the hip joints were screened with 6 mm thick T1 Weighted coronal images and shows replacement of the normal marrow of the sacrum, sacral ala, iliac bones and the visualised femora bilaterally by a hypointense signal on the T1 Weighted images.
1. A postero-central disc herniation at the L5-S1 level with
inferior migration of the disc fragment lying posterior to the S1 vertebral body.
2. A small posterior disc bulge at the L4-L5 level.
3. Altered signal of the dorso-lumbar vertebrae and the sacrum, sacral ala, iliac bones and the visualised femora bilaterally as described is not specific for a single etiology.
The differential diagnosis would include,
1. Myeloproliferative disorder.
2. Multiple myeloma.
3. Multiple metastasis.
This signal change is less likely to represent replacement of fatty marrow be red marrow.