Second MRI done Today
EXAMINATION: LUMBAR SPINE MRI WITHOUT INTRAVENOUS CONTRAST.
HISTORY: Lower back pain.
COMPARISON: None.
TECHNIQUE: Multiplanar MR imaging of the lumbar spine was
performed utilizing a 1.5 Tesla system. Sagittal and axial T1 and
T2 images obtained from the lower thoracic spine to below the
lumbar sacral junction.
FINDINGS:
The study is of good technical quality.
For the purposes of this dictation there are presumed to be five
lumbar vertebrae. Numbering is based upon the anatomic
configuration of the lumbosacral junction. Please correlate with
plain film radiographs prior to intervention.
Retroperitoneum: The visualized retroperitoneum is normal.
Vertebral bodies: Bone marrow signal intensity is normal.
Alignment is anatomic. There are no findings to support
spondylolisthesis or spondylolysis.
Conus: The conus terminates at T12. Visualized portions of the
cord demonstrate normal signal intensity.
L1/2: Normal.
L2/3: Normal.
L3/4: Normal.
L4/5: Mild settling of the disc in the sagittal plane with disc
desiccation. Shallow concentric disc Protrusion. Central/left
paracentral annular tear. The neuroforamina are patent.
L5/S1: Settling of the disc in the sagittal plane with disc
desiccation. Shallow central disc protrusion. No significant
encroachment on the thecal sac. Neural foramina are patent.
and this is the first one
LUMBAR SPINE MRI WITHOUT CONTRAST
HISTORY: Low back pain.
COMPARISON: Lumbar spine series, 29 January 2007.
TECHNIQUE: Examination was performed on a GE Signa EXCITE 1.5 Tesla
scanner. Sagittal T1, fast spin-echo T2 images were acquired through
the lumbar spine along with angled axial T2-weighted fast spin-echo
images through the disc spaces of L3-L4 through L5-S1.
FINDINGS: There is a transitional vertebral situation as there are 25
cervical/thoracic/lumbar segments on the scout images as opposed to
the usual 24. Hypoplastic ribs are noted on the inferior most
rib-bearing vertebra on the comparison plain films. For the purposes
of this interpretation, the inferior most lumbar-type segment will be
referred to as L5 and 13 rib-bearing vertebrae will be assumed.
Marrow signal of the bones imaged is normal without fractures,
contusions, or destructive lesions of bone. There is disc desiccation
at L4-L5 and L5-S1 and relative disc space narrowing at L5-S1
associated with endplate irregularity and mild signal dropout adjacent
to the endplates consistent with sclerosis with slight endplate
marginal spurring. There are several small endplate invaginations
(Schmorl’s nodes) at L2-L3 and L3-L4 not associated with adjacent
marrow edema. Alignment is normal without spondylolisthesis or focal
kyphosis of the lumbar segments. The central canal and neural foramina
are widely patent.
At L4-L5, there is broad posterior disc bulging that anatomically
appears to be inconsequential not resulting in significant central
canal or foraminal stenosis. There is, however, increased signal
amongst the posterior annulus fibrosis at L4-L5 suggestive of annular
tear which can be contributory to nonspecific back pain symptoms.
There is circumferential disc bulging at L5-S1 without significant
encroachment on the central canal, nerve roots, or neural foramina.
There is a focus of high signal amongst the anterior midline annulus
fibrosis at L5-S1 also suspicious for annular tear, again possibly
contributory to nonspecific back pain symptoms.
The conus terminates at the T13-L1 level. Portions of the cord imaged
are normal without masses, syrinx, or cord signal abnormality.
Incidentally noted on the scout images are wedge compression
deformities of T8 and T9 that morphologically are likely chronic
associated with endplate irregularity and are devoid of significant
adjacent marrow edema.
IMPRESSION:
1. Degenerative disc disease changes at L4-L5 and L5-S1 with probable
annular tears at posterior midline L4-L5 and anterior midline L5-S1
which can be contributory to low back pain symptoms. No significant
disc herniations, central canal or foraminal stenoses.
2. Incidental note of wedge compression deformities of T8 and T9
demonstrated on the scout images (nondiagnostic sequence). Recommend
correlation with clinical history for thoracic spinal trauma and
review of systems for pain referrable to the thoracic spine. Recommend
correlation with plain films.
