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Name of the Patient : Abc Xyz Jlmn / M / 67 yrs.
Referred by : Dr. Abc Xyzmpat.
Examination : M.R.I. of the Dorso-lumbar Spine.

CLINICAL PROFILE :

C/O pain in both hip joints (left more than right) and in the LLE with a limp on the left side.
H/O laminectomy at L1 with excision of tumor 2 1/2 years ago.
HP S/O chondrosarcoma (3 sittings of radiotherapy received).

EXAMINATION :

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.

OBSERVATION :

There is wedging of the L1 vertebral body, more so anteriorly.

There is still seen an expansile, lobulated mass lesion involving the L1 vertebral body. This is of intermediate signal on the T1 Weighted images and appears heterogeneously hyperintense on the T2 Weighted images. The pedicles and the
transverse processes of the L1 vertebra and the D12-L1
costo-vertebral joints are involved by the lesion. There is a bulge of the posterior margin of the L1 vertebral body with resultant compression of the tip of the conus medullaris at that level. The tip of the conus medullaris shows a hyperintense signal on the T2 Weighted images which suggests cord edema/ischemia. There is also extension of the mass lesion into the prevertebral, paravertebral soft tissues and left posterior paraspinal region over the D12-L1 to L1-L2 levels. Erosion of the inferior and superior cortical endplates of L1 is noted with a probable pathological fracture through the L1 vertebral body.
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The D9, D10, D11, D12 and L2 vertebrae show a hyperintense signal as compared to normal marrow on the T1 Weighted images which may be the sequelae of previous radiotherapy.

The lumbar intervertebral discs show loss of water content.

Posterior and bilateral far lateral disc bulges with peridiscal osteophytes are noted at the L5-S1 level.

A small posterior disc bulge is seen at the L4-L5 level.

Facetal hypertrophy is noted at the L4-L5 and L5-S1 levels.

The rest of the lumbar vertebral bodies reveal normal signal intensity. The remaining facet joints are unremarkable.

The conus medullaris terminates at the L1-L2 level and the thecal sac terminates at the S2 level.

Screening T1 Weighted sagittal images of the cervical and upper and mid-dorsal spines do not reveal any significant feature of note.

Hyperintense areas are seen on the T1 Weighted images in the right lung field (se/im 106/5) and may represent metastasis.

IMPRESSION :

Altered signal in the L1 vertebral body with a lobulated, expansile mass lesion represents a recurrence of the chondrosarcoma. Cord compression is noted on the present study with altered cord signal suggesting cord edema/ischemia.

Altered signal in the D9, D10, D11, D12 and L2 vertebral bodies is the sequelae of previous radiotherapy.

As compared to the previous MRI dated 00.00.00 (scan no. 00002), there is a slight increase in the degree of compression of the conus medullaris.

Lesions seen in the right lung may represent metastasis.


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