Patient with history of juvenile idiopathic arthritis, presenting with thoracic back pain, evaluate. Minimal dextroscoliosis of the thoracic spine is identified, better seen on recent radiograph from 7/6/2016. Otherwise the alignment is anatomic. There is diffuse T1 hypointensity and T2 hyperintensity involving the T6 vertebral body as well as the anterior aspect of the T10 vertebral body. There are endplate irregularities of the vertebral bodies at these levels, with mild loss of height involving the left aspect of the T6 vertebral body. Otherwise the remainder of the vertebral body heights are maintained. There are areas of abnormal enhancement involving the T6 and T10 vertebral bodies. No associated paraspinous or epidural soft tissue mass.There is no evidence of spinal cord signal abnormality. No spinal canal or neural foraminal stenosis is identified.
Edema and abnormal enhancement involving the T6 vertebral body and to a lesser degree T10 vertebral body with irregularity/erosion involving the inferior endplates at these levels. Differential is broad and includes: endplate erosion related to known inflammatory arthropathy with reactive edema and enhancement; chronic recurrent multifocal osteomyelitis; Langerhans cell histiocytosis or neoplastic process seem less likely but remain in the differential given the nonspecific appearance of these lesions. Appearance would also be unusual for Schmorl's nodes with reactive vertebral edema and enhancement or for bone infarcts.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.