Concern for spine osteomyelitis on chest CT. Please note lack of contrast and motion degradation limiting evaluation. There are erosive endplate changes involving the T4-T5 vertebral body endplates as seen on recent CT. There is T2/STIR hyperintensity compatible with edema involving the disc and adjacent vertebral body segments as well as posteriorly at the interspinous level to a mild degree. There is ankylosis involving the T5-T6 vertebral bodies and nonspecific T2 hyperintense foci involving the T6 vertebral body.There is diffuse T1 hypointensity involving the bone marrow which is nonspecific but favored to be related to renal osteodystrophy.There is mild to moderate loss of height associated with the T4 and T5 lytic changes and mild associated kyphotic angulation at this level. Vertebral body heights and alignment are otherwise maintained. Mild degenerative changes are evident including small disc bulge at the T4-T5 level with mild spinal canal stenosis. No high-grade spinal canal stenosis is evident at any level in the thoracic spine. There is moderate to severe neural foraminal stenosis at T4-T5.T2 hyperintensity involving the L1-L2 endplates are favored to represent Schmorl's nodes.Lumbar spine MRI sequences are severely motion degraded. Vertebral body heights and alignment are grossly maintained. Multilevel degenerative changes are seen including endplate marrow signal changes and disc bulges in the lower lumbar spine. No significant spinal canal stenosis is present at any level. No obvious epidural collection displacing the distal cord or cauda equina is demonstrated within the limits of noncontrast study.
1. Endplate destructive changes involving the T4-T5 level as seen on recent CT. No epidural or paraspinous collections to suggest abscess are appreciated within the limits of noncontrast MRI. There is also loss of disc space inferiorly at T5-T6 with bony ankylosis at this level. These findings suggest possibility that the T4-5 findings are chronic. Discitis-osteomyelitis cannot be excluded at this level. Dialysis-related arthropathy is also a possibility. 2. Severely motion degraded lumbar spine study demonstrating no large epidural collections. No findings to suggest significant spinal canal stenosis in the thoracic or lumbar spine.3. Diffuse T1 hypointensity involving the bone marrow which is nonspecific but favored to be related to renal osteodystrophy.4. Endplate changes at L1-L2 level which are suboptimally evaluated but likely represent Schmorl's nodes.