Date : 00.00.00
Name of the Patient : Abc Xyzkar Mhlmn / M / 40 yrs.
Referred by : Dr. Abc Xyz.
Examination : M.R.I. of the Dorso-lumbar Spine.
CLINICAL PROFILE :
Known C/O Hodgkins disease. Received chemotherapy.
C/O backache radiating to BLE since 2-3 months.
C/O paraplegia since 15-20 days.
H/O being hit by an object 45 days ago.
M.R.I of the dorso-lumbar 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 replacement of the normal marrow of the L4, S1 and S2 vertebral bodies by hypointense areas on the T1 Weighted images. These are seen to turn heterogeneously hyperintense on the T2 Weighted images. The pedicles of the L4 vertebral body bilaterally and the left pedicle of the L1 vertebra also show altered signal. There is prevertebral soft tissue extension at the S1 and S2 levels. Epidural extension into the left lateral recess of the S1 vertebra is seen with encasement of the traversing left S1 nerve root.
Epidural extension is also noted posterior to the L4 vertebral body with encroachment into the left neural foramina at the L4-L5 level and encasement of the foraminal portion of the left L4 nerve root.
A large posterior epidural soft tissue lesion is seen at the L1 and L2 levels which measures approximately 4.4 x 1.2 cms. This is slightly hyperintense on the T1 Weighted images and turns heterogeneously hyperintense on the T2 Weighted images. There is resultant compression on the posterior aspect of the thecal sac. Involvement of the spinous process of the L1 is noted.
A small posterior disc herniation is seen at the L5-S1 level. The lumbar intervertebral discs show slight loss of water content.
The rest of the lumbar vertebral bodies reveal normal signal intensity. The facet joints at the L5-S1 level appear hypertrophied.
The conus medullaris terminates at the L1 level and the thecal sac terminates at the S2 level.
The antero-posterior dimensions of the lumbar canal at the level of the intervertebral discs are as follows :
14.0 mm at L1-L2
15.0 mm at L2-L3
16.0 mm at L3-L4
15.0 mm at L4-L5
14.0 mm at L5-S1.
The dorsal spine was screened with 5 mm thick T1 Weighted sagittal and axial images. There is replacement of the normal marrow of the D4 vertebral body by hypointense areas. Right paravertebral soft tissue extension is noted. A small right lateral epidural lesion is seen to displace the spinal cord to the left. The visualized spinal cord shows normal signal intensity. The iliac bone and the sacral ala on the right side also shows hypointense areas.
In a known C/O lymphoma, the MRI features are suggestive of altered signal of the D4, L4, S1 and S2 vertebral bodies, iliac bone and sacral ala on the right side, with paravertebral and epidural soft tissue extensions as described.
These most likely represent lymphomatous deposits.