Name of the Patient : Abc Xyzben Slmn / F / 58 yrs.
Referred by : Dr. Abc Xyzah.
Examination : M.R.I. of the Lumbo-sacral Spine.
CLINICAL PROFILE :
C/O backache with weakness of BLE with loss of bladder control.
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.
After administration of contrast, the following parameters were used :
5 mm thick T1 Weighted sagittal and axial images.
3 mm thick T1 Weighted coronal images.
4 mm and 5 mm thick T1 Weighted sagittal images through the dorsal and cervical spines, respectively.
The L4 vertebral body is centrally wedged and shows areas of hypointensity on the T1 Weighted and T2 Weighted images (few areas turn mildly hyperintense on the T2 Weighted images). After contrast administration, they show mild enhancement. Similar signal change is noted in the distal sacral segments.
There is evidence of an intradural/extramedullary mass lesion at the L1 vertebral level indenting the conus medullaris. This is hypointense on the T1 Weighted and T2 Weighted images and is seen to enhance. Also seen are multiple small areas of enhancement along the surface of the dorsal spinal cord over the D6 to D12-L1 levels. The intrathecal nerve roots in the lumbar region are also seen to enhance.
There is a left paracentral disc herniation indenting the traversing left S1 nerve root at the L5-S1 level.
Also seen is a posterior disc herniation with peridiscal osteophytes indenting the thecal sac and narrowing both neural foramina at the L4-L5 level. There is impingement of the traversing left L5 nerve root at this level. Also seen is a left far lateral disc herniation at the L4-L5 level.
The L4-L5 and L5-S1 facet joints show hypertrophic degenerative changes.
The C4 and C5 vertebral bodies appear slightly hypointense on the T1 Weighted images.
The lumbar intervertebral discs show loss of water content.
The rest of the lumbo-cervico-dorsal vertebral bodies show areas of fatty replacement of normal marrow.
The remaining facet joints and the visualized pre and paravertebral soft tissues are unremarkable.
The conus medullaris terminates at the L1 level and the thecal sac terminates at the S1 level.
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The antero-posterior dimensions of the lumbar canal at the level of the intervertebral discs are as follows :
18.0 mm at L1-L2
18.0 mm at L2-L3
17.0 mm at L3-L4
14.0 mm at L4-L5
13.0 mm at L5-S1.
The MRI features are suggestive of :
1. Areas of altered signal intensity involving the L4 vertebral body and the distal sacral segments.
2. An intradural/extramedullary mass lesion at the L1 vertebral level and abnormal enhancement along the surface of the lower dorsal spinal cord and lumbar intrathecal nerve roots.
The above features may suggest presence of multiple secondaries.
3. A posterior disc herniation with a tight canal at the L4-L5 level.
4. A left paracentral disc herniation with peridiscal osteophytes at the L5-S1 level.
5. Hypertrophic facetal arthropathy at the L4-L5 and L5-S1 levels.