History of fevers. Prior imaging with concern for discitis. Evaluate for osteomyelitis discitis Lumbar Spine:Redemonstrated postoperative changes from L4-5 posterior spinal fusion. Susceptibility artifact related to the hardware limits evaluation of this region. The vertebral body heights are preserved. Alignment is anatomic. Again seen is mildly increased STIR signal and mild enhancement within the T12 vertebral body. There are small Schmorl's nodes and degenerative endplate irregularity at T11-12, but there is no frank osseous destruction identified. The T11-12 disc shows nonspecific increased T2 signal but no pathologic enhancement. Marrow signal within the T11 vertebral body is normal. No epidural collections are identified at this level.Multiple small renal cysts are seen bilaterally.Additional level by level findings are as follows:T11-12: No disc bulge. Moderate facet hypertrophy creates mild right neural foraminal stenosis. No significant spinal canal stenosis or left neural foraminal stenosis. T12-L1: No disc bulge, spinal canal stenosis, or neuroforaminal narrowing.L1-L2: Marked degeneration of the right facet joint. Mild asymmetric thickening of the right dorsal epidural tissues with mild enhancement with no obvious fluid collections. No significant spinal canal or neural foraminal stenosis.L2-L3: Bilateral facet arthropathy, hypertrophy of the ligamentum flavum and mild disc bulge create mild spinal canal and mild left neural foraminal narrowing. No significant right neural foraminal narrowing. Mild thickening and enhancement of the dorsal epidural tissues is also seen without evidence of a fluid collection.L3-L4: Facet arthropathy and hypertrophy of ligamentum flavum without significant spinal canal or neural foraminal stenosis. L4-L5: There are degenerative fatty endplate changes and marked disc degeneration. Diffuse disc bulge/osteophytic spurring and bilateral facet arthropathy. Severe right and moderate left neural foraminal narrowing. No significant spinal canal stenosis. There is a 12 mm fluid collection in the right paraspinal soft tissues adjacent to the spinous process of uncertain clinical significance. No adjacent soft tissue inflammation.L5-S1: Bilateral facet arthropathy and hypertrophy of the ligamentum flavum. Severe bilateral neural foraminal stenosis.
1. Abnormal marrow signal and subtle enhancement within the T12 vertebral body and abnormal T2 signal (without enhancement) of the adjacent T11-12 disc without without frank osseous destruction, or significant adjacent soft tissue inflammation, or epidural collection. Findings are nonspecific and could represent early infection versus inflammatory (either degenerative or traumatic) etiologies.2. Previously questioned ventral epidural fluid collection at the L1-2 level is not clearly identified on this dedicated exam. Instead there is mild dorsal epidural soft tissue thickening at L1-2 and L2-3 with mild enhancement. This may represent mild inflammation adjacent degenerated facets, less likely a manifestation of infection.3. Nonspecific 12 mm fluid collection in the right paraspinal soft tissues at the L4-5 level of uncertain significance.4. Multilevel degenerative changes with associated neural foraminal narrowing at L4-5 and L5-S1.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.