EXAM: MRI Lumbar Spine
HISTORY: Low back pain status post lifting injury.
TECHNIQUE: Multiplanar, multisequence MR imaging of the lumbar spine. No intravenous contrast was administered.
COMPARISON: None are available.
FINDINGS: Multiple small lesions within the T12, L2, L4 and L5 vertebral bodies and throughout the visualized pelvis measuring up to 1.3 cm with surrounding edema most compatible with metastatic disease. No pathologic compression fracture. Normal
alignment without listhesis. No epidural fluid collection. The conus medullaris terminates at the L1 level.
L1-2: No degenerative changes, disc bulge, herniation, central canal or neural foraminal stenosis.
L2-3: No degenerative changes, disc bulge, herniation, central canal or neural foraminal stenosis.
L3-4: No degenerative changes, disc bulge, herniation, central canal or neural foraminal stenosis.
L4-5: No degenerative changes, disc bulge, herniation, central canal or neural foraminal stenosis.
L5-S1: 6 mm thick left subarticular disc extrusion and associated annular fissure effacing the left lateral recess with mild dorsal displacement of the left S1 nerve root minimally narrowing the thecal sac. Mild disc space narrowing and mild bilateral
neural foraminal stenosis.
This interpretation assumes 5 lumbar type vertebral segments.
IMPRESSION:
- Numerous small lesions scattered throughout the bone marrow, most pronounced involvement of the sacrum, and most compatible with metastatic disease.
- L5-S1 left subarticular disc extrusion effaces the left lateral recess and dorsally displaces the left S1 nerve root minimally narrowing the thecal sac. Mild disc space narrowing and mild neural foraminal stenosis.
UPDATE 2
MRI Thoracic Spine W / WO (72157)
HISTORY:
Back pain. Osseous metastases.
TECHNIQUE:
Noncontrast MRI thoracic spine performed with sagittal T1, T2, and T2 STIR, and axial T1 and T2 weighted sequences.
Postcontrast MRI was performed with axial and fat saturated sagittal postcontrast T1 sequences obtained after administration of 15 mL there is scan IV contrast.
COMPARISON:
None.
FINDINGS:
Numbering: Typical numbering, with 12 rib-bearing thoracic type vertebrae numbered T1-T12.
Surgeries: No thoracic spine surgery appreciated.
Spinal Alignment: Mild convex rightward thoracic spine curvature without frank scoliosis. Well-maintained thoracic kyphosis. No spondylolisthesis.
Bones: Multiple marrow replacing T1 hypointense, STIR hyperintense, enhancing lesions are seen scattered throughout the included spine, with a dominant 1.3 cm lesion at T9, and smaller lesions at almost every other thoracic level involving the vertebral
bodies and posterior elements and ribs. No expansile lesions or extraosseous extension of disease. No pathologic fractures. Surrounding marrow edema seen at the lesions. Multiple prominent Schmorl's nodes.
Disc Spaces: Disc desiccation seen in the majority of the field-of-view, but relatively well-maintained disc heights. Prominent left paracentral annular fissure seen at T11-T12, with small central T4-T5, central T8-T9 and left paracentral T9-T10 annular
fissures noted.
Spinal Canal/Neural Foramina: Moderate left paracentral disc protrusion at T11-T12 contributes to moderate spinal canal stenosis. Smaller disc bulges/protrusions and ligamentum flavum thickening and facet hypertrophy at other levels contributes to mild
spinal canal stenosis. Mild bilateral T11-T12 neural foraminal narrowing.
Spinal Cord: Mild ventral cord deformities seen at T4-T5, T8-T9, T9-T10, and T11-T12. No other cord compression or deformity. No cord hemorrhage or cord edema to suggest acute cord injury, and no cord cystic changes or cord volume loss above or below
the level of deformity to suggest extensive myelomalacia. The remainder of the thoracic spinal cord is normal in size, shape, and signal intensity. No abnormal medullary or leptomeningeal enhancement.
Soft Tissues: Interstitial thickening and bronchial wall thickening in the posterior segment of the right upper lobe, not well evaluated this exam.
IMPRESSION:
- Multiple osseous lesions consistent with osseous metastasis. No acute bony findings.
- Moderate spinal canal stenosis T11-T12 with mild spinal canal stenosis at other levels. Multilevel mild cord deformities without evidence of acute cord injury or extensive myelomalacia.
- Abnormality in the right upper lobe not well evaluated on this exam, could be further evaluated by dedicated chest imaging.
Report Ends
UPDATE 3
MRI Cervical Spine W / WO (72156)
HISTORY:
Osseous metastasis.
TECHNIQUE:
Noncontrast MRI cervical spine with coronal T2, sagittal T1, T2, and T2 STIR, and axial spin-echo and gradient T2 weighted sequences.
Postcontrast MRI was performed with axial and sagittal postcontrast fat-saturated T1 sequences obtained after administration of 15 mL Clariscan IV contrast.
COMPARISON:
None.
FINDINGS:
Surgeries: No prior spinal surgery appreciated.
Spinal Alignment: Straightening of normal cervical lordosis, which may be positional. Otherwise normal alignment.
Bones: There is some susceptibility artifact which mildly limits evaluation of marrow signal intensity in the cervical spine, but no appreciable marrow placing or stir hyperintense or enhancing lesions appreciated in the cervical spine or included skull
base. Probable osseous metastases seen in the partially included upper thoracic spine. No acute appearing bony lesions. Well-maintained vertebral body heights and intact endplates.
Disc Spaces: Mild disc desiccation in the cervical spine. Well-maintained disc heights. No appreciable annular fissures.
Ligaments: Intact and nonedematous.
Individual Levels:
C1-C2: Normal.
C2-C3: Normal.
C3-C4: Normal.
C4-C5: Normal.
C5-C6: Normal.
C6-C7: Normal.
C7-T1: Normal.
Included Thoracic Spine: Normal.
Spinal Cord: The cervical and included thoracic spinal cord are normal in size, shape, and signal intensity, without evidence of acute or chronic cord injury. Included intracranial contents are grossly unremarkable. No abnormal medullary or
leptomeningeal enhancement.
Soft Tissues: Heterogeneity seen in the bilateral submandibular glands, not well evaluated on this exam. No obviously pathologic lymphadenopathy in the neck.
IMPRESSION:
No appreciable osseous metastases in the cervical spine. No acute appearing findings. Heterogeneity of the bilateral submandibular glands, not well evaluated on this exam. No obvious pathologic lymphadenopathy in the neck.
Report Ends
There was some new terms used in my last MRI and when I asked my provider in a message was asked to come in. I’m not new to these tests at all but I am worried about this one as I continue to worsening issues.
MRI results below main worry is c3-c4 and second paragraph dealing with cervical junction.
Thank you for any help.
Post op changes C3-C4 interbody fusion. ACDF C4-C7. Signal void artifact limiting image quality. Similar persistent straightening of the cervical spine, suggesting muscle spasm. Grossly unremarkable alignment of the cranial cervical junction with predominantly low signal soft tissue thickening around the odontoid process, likely related to chronic synovitis or ligamentous injury. Stable small cystic change in the odontoid process. Again is noted unchanged well corticated bone fragment anterior to C2 seen on the radiograph and on the prior MRI (series 6, image 6). This possibly related to an old injury at this level.. Grossly unchanged multilevel disc osteophyte complex and facet joint hypertrophy associated with varying degree of thecal sac and bilateral neural foraminal narrowing. Diffusion sequences are suboptimal to interpret because of the metallic artifacts. A level by level analysis is as follows: C2-C3: There is no significant disc disease or stenosis. C3-C4: Mild disc osteophyte complex. Mild effacement of the thecal sac. With minimal deformity of the spinal cord. There is slight increase in the previously described cord edema, likely myelomalacia, seen mostly behind C4 and is more significant on the right side (series 3, image 24; series 6 image 5; series 9 image 19/20). This extends for a craniocaudal distance of around 1.2 cm. Severe bilateral foraminal narrowing. C4-C5: Mild disc osteophyte complex, mostly centrally. Mild effacement of the thecal sac. Mild deformity of the cord. Moderate bilateral neural foraminal narrowing more on the right side.... C5-C6: Mild disc osteophyte complex more on the right. Mild effacement of the thecal sac. Mild cord deformity. Mild right neural foraminal narrowing, C6-C7: Mild disc osteophyte complex. Mild effacement of the thecal sac. Mild left neural foraminal narrowing.. C7-T1: No significant abnormality... IMPRESSION Impression: 1. Prior postop changes interbody fusion C3-C4. ACDF C4-C7. No interval complications. 2. Multilevel degenerative disc disease. This is most significant at C3-C4 with marked foraminal narrowing. 3. The degenerative changes are grossly stable; however for mild increase in myelomalacia behind C4. 4. Chronic stable changes at C1-C2.