Reason: diffusion imaging, r/o infection History: lower back pain, sepsis. Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. There is diffuse marrow replacement present.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There are endplate reactive changes at this level, loss of disk space height and a diffuse disk bulge the disk signal is hyperintense on T1 imaging.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is loss of disk space height T2 signal hyperintensity within the disk and diffuse disk bulge at this level associated with mild to moderate bilateral facet and ligamentum flavum hypertrophy. There is mild narrowing of the neural foramina bilaterally with partial effacement of the fat within the neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is loss of disk space height mild disk desiccation and a minor disk bulge at this level.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.Within the right psoas muscle there is signal change associated with a small fluid collection measuring approximately 7 by 11 mm in axial dimensions.There are multiple cysts present in both kidneys.The examination is degraded due to low signal to noise quantum mottle.
1.There degenerative changes present in the lower lumbar spine which have not changed since the prior exam and are without significant compromise of spinal canal or exiting nerve roots. There signal changes within the L4-5 disk space associated with some endplate reactive changes which are somewhat nonspecific. This could very well be related to degenerative change. There is an associated small cystic lesion in the right psoas muscle at the L5-S1 disk space level which could represent a small abscess. The possibility of diskitis and paraspinous abscess cannot be excluded. Since a contrast-enhanced MRI is higher risk for NSF based on renal function then a CT of the lumbar spine may be of further benefit to further delineate the psoas lesion - if the patient is on dialysis and if clinically appropriate. Given the possibility of two disk space level involvement, the possibility of TB cannot be excluded. Another explanation can be discitis related to hemodialysis related amyloid arthropathy or a combination of the above.2.There is diffuse marrow replacement present throughout the visualized spine. This could represent secondary hyperparathyroidism .3.Multiple renal cysts in both kidneys. The kidneys are relatively small.4.Findings were discussed with Mia Weiss at 8:40 am on 3/3/15.