My MRI results, Dr. Young could you translate?

Carl R · 05-08-2003, 12:47 PM

I have been having several different problems over the last couple of months. Mostly related to my lower abdomen and lower back pain, and some reduction in trunk strength and balance. Anyway, I had an MRI approximately two weeks ago and I received the results in the mail yesterday. I am still waiting on getting the images on CD, and have not had an appointment with my doctor yet to discuss results. I Am also trying to get in to see Dr. Donovan to get his opinion as well. I thought I had a better understanding of the terminology, but quite a bit of this report is Greek to me.

Dr. Young, can you translate the following results and give me your opinion of the findings? Thanks.

MRI Cerv Spine WO Contras

History: Spinal Cord Injury

Technique: Non-contrast MRI of the cervical spine

Findings:
There are no prior studies available for comparison. There is metallic artifact with poor visualization of the disk spaces from the C4 down to the C7 vertebral body levels. This is suggestive of anterior fixation with bone graft, metallic plate and screws.

There is abnormal signal intensity within the cord from the upper C4 to the upper C6 vertebral body level with T2-hyperintensity and xT1-hypointensity. The signal intensity is similar to cerebrospinal fluid in this region and the cork is enlarged and irregular with only a thin rind of soft tissue seen at several levels. These findings are suggestive of cystic changes. There is an area of blooming on the axial gradient echo images within the inferior aspect of this area of abnormal signal intensity suggesting hemorrhagic products most likely hemosiderin. The cord is overall enlarged in this region although CSF is seen surrounding the cord. On the axial T1 and T2-weighted, there is area of moderate T2-hypointensity in the region of the anterior epidural space and slight hypointensity on T1-weighted images. This may represent an area of ossification. It is seen best on the axial images #10 & 11 on the gradient echo and T1-weighted imaged. It is not well seem on the sagittal images, however. Therefore, a metallic artifact cannot be excluded.

There is no evidence of canal stenosis from bony or soft tissue elements.

C2-C3: There are prominent vascular structures in the bilateral proximal foraminal regions extending into the foramen. There is no evidence of significant canal or neural foraminal stenosis.

Cc3-4: There are prominent vascular structures in the bilateral foramina. There is bilateral facet hypertrophy and mild bilateral uncovertebral joint hypertrophy. There is asymmetric mild narrowing of the left neural foramen.

C4-5: There are prominent vascular structures in the foraminal region. The right posterior lamina demonstrates a defect. There is mild bilateral uncovertebral joint hypertrophy. The facet joints are not well seen and are probably fused.

C5-6: There are defects in the regions of the posterior elements. The facet joints are not well seen and are probably fused. There are prominent vascular structures in the neural foramen.

C6-7: There are areas of defects in the posterior elements. The facet joints are not well seen and are probably fused. The neural foramina demonstrates heterogeneous signal intensity in part from the metallic artifact and prominent vascular structures.

C7-T1: There is heterogeneous signal intensity in portions of the neural foramen from metallic artifact. There in no definite evidence of significant foraminal stenosis.

Impression:

Abnormal signal intensity and enlargement within the cervical cord consistent with the history of spinal cord injury

Status post fixation with postoperative changes

Interval stability cannot be determined without prior films

MRI Lum Spine WO Contrast

History: Spinal cord injury

Technique: Non-contrast MRI of the lumbar spine.

Findings:

It is assumed for counting purposes there are five non-rib-bearing lumbar vertebral bodies. There is vestigial S1-S2 disk.

L5-S1: There is degenerateive disk disease with mild disk space narrowing. There is a diffuse disk bulge which is slightly more prominent in the central region suggesting a shallow protrusion. There is a mild to moderate bilateral facet hypertrophy and mild ligamentum flavum hypertrophy. There is congenital narrowing of the thecal sac at this level although there is effacement of the ventral epidural fat. The bulge and shallow protrusion extends into the region of the S1 nerve roots and there is mild narrowing of the bilateral proximal meural foramen and lateral recesses. There is T2 hyperintensity within the posterior annulus on the sagittal images suggesting a posterior annular tear in the central region.

L$-5: There is a diffuse disk bulge and mild to moderate bilatereral facet hypertrophy. Ther is no evidence of significant canal stenosis. There is relative narrowing of the bilatereal proximal inferior neural foramen.

L3-4: There is a mild disk bulge and mild bilateral facet hypertrophy.

L2-3: There is a mild disk bulge and mild bilateral facet hypertrophy. Motion artifact slightly obscures the images.

L1-2: No significant radiographic abnormality.

There is a Schmorl's node within the inferior end plate of the L1 vertebral body. The distral cord and conus medullaris demonstrate normal signal intensity. The conus medullaris ends at the lower L1 vertebral body level.

There is a area of T1 and T2 hyperintenisty within the upper anterior S1 vertebral body suggesting hemangioma.

Impression:

Degenerative changes with shallow L5-S1 central protrusion.

MRI Thor Spine WO Contrast

Non-contrast, multi-planar, multi-sequence imaging of the thoracic spine was preformed. There are no comparison studies

History: Truncal weakness

Findings: There is no vertebral body collapse, vertebral edema or subluxation. There is mild superior end-plate depression of T3 and T4 without bone marrow edema, small end-plate disk herniations are present.

The thoracic cord is without signal alteration or compression. There is no spondylotic foraminal or spinal canal stenosis. There is mild scoliotic curve of he lower thoracic spine convex to the right. The paravertebral soft tissues are unremarkable. Incidental notes is made of anterior cervical fusion hardware at C7.

Impression:

Unremarkable MRI of the thoracic spine for vertebral body collapse, cord compression or herniated disk.

Wise Young · 05-08-2003, 05:53 PM

Carl, a quick perusal of the report suggest that, except for some mild degenerative changes in your lower spine (lumbar), your spinal column and cord appear to be in reasonable shape. At the injury site, there is of course evidence of your previous injury but no compression. Wise.

Carl R · 05-08-2003, 09:32 PM

Thanks Dr Young...Is there any reason to be concerned about the degeneration or is this fairly common after SCI or is it unrelated?

Quote:

There is a Schmorl's node within the inferior end plate of the L1 vertebral body. The distral cord and conus medullaris demonstrate normal signal intensity. The conus medullaris ends at the lower L1 vertebral body level.

There is a area of T1 and T2 hyperintenisty within the upper anterior S1 vertebral body suggesting hemangioma.

What is a Schmorl's node? And what is hemangioma?

Thanks again. The report sounded like I was pretty messed up.

Wise Young · 05-09-2003, 04:29 PM

Schmorl's nodes. Here is probably the best explanation and pictures of Schmorl's nodes: http://uscneurosurgery.com/glossary/...rls%20node.htm
It is just a herniation of the disc into the adjacent vertebral body. It happens when there is wearing down of the vertebral bone. It usually is not associated with any problems for the spinal cord and is consistent with mild degenerative bony changes mentioned in the report.

Hemangioma. When there is an increase in signal intensity in bone, this usually means that there is increased fluid (water contains hydrogen and hydrogen is what produces the signal in MRI). One of the most common sources of increased signal in bone is the increase presence of blood vessels. The most common cause of an increase in blood vessels is an hemangioma which is a small benign collection of blood vessels. Although it is called a tumor, it is not worrisome and does not require treatment.
http://bonetumor.org/tumors/pages/page132.html

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05-08-2003, 12:47 PM	#1
Carl R Senior Member Join Date: Jul 2001 Location: Houston, Tx. USA Posts: 1,888	My MRI results, Dr. Young could you translate? I have been having several different problems over the last couple of months. Mostly related to my lower abdomen and lower back pain, and some reduction in trunk strength and balance. Anyway, I had an MRI approximately two weeks ago and I received the results in the mail yesterday. I am still waiting on getting the images on CD, and have not had an appointment with my doctor yet to discuss results. I Am also trying to get in to see Dr. Donovan to get his opinion as well. I thought I had a better understanding of the terminology, but quite a bit of this report is Greek to me. Dr. Young, can you translate the following results and give me your opinion of the findings? Thanks. MRI Cerv Spine WO Contras History: Spinal Cord Injury Technique: Non-contrast MRI of the cervical spine Findings: There are no prior studies available for comparison. There is metallic artifact with poor visualization of the disk spaces from the C4 down to the C7 vertebral body levels. This is suggestive of anterior fixation with bone graft, metallic plate and screws. There is abnormal signal intensity within the cord from the upper C4 to the upper C6 vertebral body level with T2-hyperintensity and xT1-hypointensity. The signal intensity is similar to cerebrospinal fluid in this region and the cork is enlarged and irregular with only a thin rind of soft tissue seen at several levels. These findings are suggestive of cystic changes. There is an area of blooming on the axial gradient echo images within the inferior aspect of this area of abnormal signal intensity suggesting hemorrhagic products most likely hemosiderin. The cord is overall enlarged in this region although CSF is seen surrounding the cord. On the axial T1 and T2-weighted, there is area of moderate T2-hypointensity in the region of the anterior epidural space and slight hypointensity on T1-weighted images. This may represent an area of ossification. It is seen best on the axial images #10 & 11 on the gradient echo and T1-weighted imaged. It is not well seem on the sagittal images, however. Therefore, a metallic artifact cannot be excluded. There is no evidence of canal stenosis from bony or soft tissue elements. C2-C3: There are prominent vascular structures in the bilateral proximal foraminal regions extending into the foramen. There is no evidence of significant canal or neural foraminal stenosis. Cc3-4: There are prominent vascular structures in the bilateral foramina. There is bilateral facet hypertrophy and mild bilateral uncovertebral joint hypertrophy. There is asymmetric mild narrowing of the left neural foramen. C4-5: There are prominent vascular structures in the foraminal region. The right posterior lamina demonstrates a defect. There is mild bilateral uncovertebral joint hypertrophy. The facet joints are not well seen and are probably fused. C5-6: There are defects in the regions of the posterior elements. The facet joints are not well seen and are probably fused. There are prominent vascular structures in the neural foramen. C6-7: There are areas of defects in the posterior elements. The facet joints are not well seen and are probably fused. The neural foramina demonstrates heterogeneous signal intensity in part from the metallic artifact and prominent vascular structures. C7-T1: There is heterogeneous signal intensity in portions of the neural foramen from metallic artifact. There in no definite evidence of significant foraminal stenosis. Impression: Abnormal signal intensity and enlargement within the cervical cord consistent with the history of spinal cord injury Status post fixation with postoperative changes Interval stability cannot be determined without prior films MRI Lum Spine WO Contrast History: Spinal cord injury Technique: Non-contrast MRI of the lumbar spine. Findings: It is assumed for counting purposes there are five non-rib-bearing lumbar vertebral bodies. There is vestigial S1-S2 disk. L5-S1: There is degenerateive disk disease with mild disk space narrowing. There is a diffuse disk bulge which is slightly more prominent in the central region suggesting a shallow protrusion. There is a mild to moderate bilateral facet hypertrophy and mild ligamentum flavum hypertrophy. There is congenital narrowing of the thecal sac at this level although there is effacement of the ventral epidural fat. The bulge and shallow protrusion extends into the region of the S1 nerve roots and there is mild narrowing of the bilateral proximal meural foramen and lateral recesses. There is T2 hyperintensity within the posterior annulus on the sagittal images suggesting a posterior annular tear in the central region. L$-5: There is a diffuse disk bulge and mild to moderate bilatereral facet hypertrophy. Ther is no evidence of significant canal stenosis. There is relative narrowing of the bilatereal proximal inferior neural foramen. L3-4: There is a mild disk bulge and mild bilateral facet hypertrophy. L2-3: There is a mild disk bulge and mild bilateral facet hypertrophy. Motion artifact slightly obscures the images. L1-2: No significant radiographic abnormality. There is a Schmorl's node within the inferior end plate of the L1 vertebral body. The distral cord and conus medullaris demonstrate normal signal intensity. The conus medullaris ends at the lower L1 vertebral body level. There is a area of T1 and T2 hyperintenisty within the upper anterior S1 vertebral body suggesting hemangioma. Impression: Degenerative changes with shallow L5-S1 central protrusion. MRI Thor Spine WO Contrast Non-contrast, multi-planar, multi-sequence imaging of the thoracic spine was preformed. There are no comparison studies History: Truncal weakness Findings: There is no vertebral body collapse, vertebral edema or subluxation. There is mild superior end-plate depression of T3 and T4 without bone marrow edema, small end-plate disk herniations are present. The thoracic cord is without signal alteration or compression. There is no spondylotic foraminal or spinal canal stenosis. There is mild scoliotic curve of he lower thoracic spine convex to the right. The paravertebral soft tissues are unremarkable. Incidental notes is made of anterior cervical fusion hardware at C7. Impression: Unremarkable MRI of the thoracic spine for vertebral body collapse, cord compression or herniated disk.

05-08-2003, 05:53 PM	#2
Wise Young Administrator Join Date: Jul 2001 Location: New Brunswick, NJ, USA Posts: 37,988	Carl, a quick perusal of the report suggest that, except for some mild degenerative changes in your lower spine (lumbar), your spinal column and cord appear to be in reasonable shape. At the injury site, there is of course evidence of your previous injury but no compression. Wise.

05-09-2003, 04:29 PM	#4
Wise Young Administrator Join Date: Jul 2001 Location: New Brunswick, NJ, USA Posts: 37,988	Schmorl's nodes. Here is probably the best explanation and pictures of Schmorl's nodes: http://uscneurosurgery.com/glossary/...rls%20node.htm It is just a herniation of the disc into the adjacent vertebral body. It happens when there is wearing down of the vertebral bone. It usually is not associated with any problems for the spinal cord and is consistent with mild degenerative bony changes mentioned in the report. Hemangioma. When there is an increase in signal intensity in bone, this usually means that there is increased fluid (water contains hydrogen and hydrogen is what produces the signal in MRI). One of the most common sources of increased signal in bone is the increase presence of blood vessels. The most common cause of an increase in blood vessels is an hemangioma which is a small benign collection of blood vessels. Although it is called a tumor, it is not worrisome and does not require treatment. http://bonetumor.org/tumors/pages/page132.html