Date : 00.00.00
Name of the Patient : Abc Xyza Panlmn / F / 60 yrs.
Referred by : Dr. Abc Xyzodak.
Examination : M.R.I. of the Cervical Spine.
CLINICAL PROFILE :
C/O neckpain with radiation to the BUE with paresthesias in BUE and LLE.
Patient is a known C/O rheumatoid arthritis.
M.R.I of the cervical spine was performed using the following parameters :
4 mm thick T1 Weighted and T2 Weighted sagittal images.
5 mm thick T1 Weighted and Fast Scan (T2 *) axial images.
4 mm thick T1 Weighted coronal images.
There is loss of normal cervical lordosis.
Ill-defined areas of hypointensity on the T1 Weighted images are seen in the periodontoid space with an increase in the atlanto-dens interval (approximately 9.00 mms). There is involvement of the odontoid process, the left lateral mass of the C1 and C2 vertebrae and the anterior arch of the atlas. These areas show mixed signal characteristics on the T2 Weighted and Fast Scan (T2 *) images. Irregularity of the margin of the odontoid process is noted.
The C3-C4, C4-C5, C5-C6 and C6-C7 intervertebral discs are decreased in height.
A postero-central disc herniation is noted at the C6-C7 level and a postero-central disc protrusion is seen at the C2-C3 level. Posterior disc bulges are noted at the C3-C4 and C4-C5 levels.
Posterior peridiscal osteophytes are seen at the C3-C4, C4-C5, C5-C6 and C6-C7 levels.
There is massive enlargement of the thyroid gland.
The cervical intervertebral discs show loss of water content. The rest of the cervical vertebrae show areas of fatty replacement of normal marrow.
The cervical spinal cord reveals normal signal intensity.
The cervico-medullary junction is unremarkable.
The MRI features are suggestive of :
1. A pathologic process involving the atlanto-axial region with atlanto-dens subluxation as described. In a known C/O rheumatoid arthritis, pannus should be considered as a likely possibility. (Infective or neoplastic processes may have a similar appearance).
2. A postero-central disc herniation at the C6-C7 level.
3. Posterior peridiscal osteophytes at the C3-C4, C4-C5, C5-C6 and C6-C7 levels.
4. Enlarged thyroid gland, which requires further evaluation.