Date : 00.00.00
Name of the Patient : Abc Xyzh Glmn / M / 18 yrs.
Referred by : Dr. Abc Xyzaubal.
Examination : M.R.I. of the Lumbo-sacral Spine.
CLINICAL PROFILE :
C/O backache radiating to the RLE since 3-4 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.
6 mm thick T1 Weighted coronal images.
There are areas of hypointensity on the T1 Weighted images which turn hyperintense on the T2 Weighted images within the right inferior articular facet of the L3 vertebra and the right superior articular facet of the L4 vertebra with involvement of the right L3-L4 facet joint. Areas of hyperintensity on the T2 Weighted images are seen within the paraspinal muscles bilaterally (right more than left) over the L3 to the L5-S1 levels.
The L4-L5 facet joints show degenerative changes.
There is a mild posterior disc bulge at the L5-S1 level.
Hypointense areas on the T1 Weighted images are noted within the sacral ala and iliac wings adjacent to both the sacro-iliac joints.
The lumbar vertebral bodies and the intervertebral discs reveal normal signal intensity. The rest of the facet joints and the visualized pre and paravertebral soft tissues are unremarkable.
The conus medullaris terminates at the D12-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
17.0 mm at L2-L3
14.0 mm at L3-L4
12.0 mm at L4-L5
10.0 mm at L5-S1.
The MRI features are suggestive of a pathologic process involving the L3-L4 facet joints and the adjacent articular facets as described and this most likely is inflammatory/infective (? tuberculosis) in etiology. There is probable involvement of the sacro-iliac joints bilaterally and a dedicated study of the same may be performed if clinically indicated.
The possibility of this being a neoplastic process is less likely.