Date : 00.00.00
Name of the Patient : Abc XyzSlmn / M / 25 yrs.
Referred by : Dr. Abc Xyz Shah.
Examination : M.R.I. of the Lumbo-sacral Spine.
CLINICAL PROFILE :
C/O backache with pain radiating to the RLE since 1-2 months.
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 appears to be sacralization of the L5 vertebra and the L2 vertebral body is as marked on the film. Please correlate with plain radiographs.
There is replacement of the normal marrow of the L4 and L5 vertebral bodies by hypointense areas on the T1 Weighted images. These are seen to turn heterogeneously hyperintense on the T2 Weighted images. The L5-S1 intervertebral disc is involved by the pathology. There is pre and paravertebral soft tissue extension over the L4 to the S1 vertebral levels. This is hypointense with a hyperintense periphery on the T1 Weighted images and turns hyperintense with a hypointense periphery on the T2 Weighted images and would represent an abscess. There is encroachment into the L4-L5 neural foramina bilaterally with encasement of the exiting L4 nerve roots. Minimal anterior epidural extension is noted at the L4 and L4-L5 levels with indentation upon the thecal sac.
The rest of the lumbar vertebral bodies and the remaining intervertebral discs reveal normal signal intensity. The facet joints are unremarkable.
The conus medullaris terminates at the D12-L1 level and the thecal sac terminates at the S1 level.
The MRI features are suggestive of :
1. A pathologic process involving the L4 and L5 vertebral bodies with pre and paravertebral soft tissue extension over the L4 to the S1 vertebral levels as described. This most probably represents a granulomatous infective process like tuberculosis.
The possibility of this being a neoplastic process like a round cell tumor seems less likely.
2. Probable sacralization of the L5 vertebra. Please correlate with plain radiographs.