Ataxia and weakness. Rule out spinal tumor or involvement by multiple sclerosis. THORACIC SPINE:There is moderate-to-severe spinal canal stenosis in the lower cervical spine. Also, the thyroid gland is diffusely enlarged. Please refer to the report of the cervical spine MRI from the day prior for more details.Thoracic spinal alignment is anatomic. The vertebral bodies are preserved in height. Marrow signal is notable for fat-containing lesions in T7, T9 and T12 vertebral bodies and most probably represent intraosseous lipomas or hemangiomas. There is no suspicious marrow abnormality, otherwise. Right anterolateral bridging osteophytes are present at T7-T12, most pronounced at T9-T10. The intervertebral discs show variable loss of T2 signal and mild height loss but there is no significant disc pathology. The thoracic spinal canal is preserved. There is also no significant neuroforaminal stenosis. The thoracic spinal cord shows normal morphology and signal. There is no abnormal thoracic spinal cord, leptomeningeal or nerve root contrast enhancement. Paraspinal tissues are notable for a 4 mm T2-hyperintense, T1-hypointense, non-contrast enhancing lesion in the upper pole of the left kidney which is incompletely assessed though likely represents a cyst. There is also a dilatation of the included extrahepatic bile duct, up to 10 mm for the pancreatic segment of the common bile duct. The gallbladder is also partially visualized and not enlarged.LUMBAR SPINE:There are 5 lumbar type, ribless vertebrae. The last well-formed disc is at L5-S1. Lumbar spinal alignment is anatomic. The vertebral bodies are preserved in height. Fat-containing lesion in the first sacral segment is probably either intraosseous lipoma or a hemangioma. There is no suspicious marrow abnormality, otherwise. The intervertebral discs are preserved in height but show partial loss of the T2 signal, compatible with desiccation. The spinal canal is fairly preserved. The conus medullaris tip is at the lower L1 level. The conus shows normal morphology and signal characteristics. There is increased contrast enhancement and STIR signal in the interspinous ligament at L3-L4 and to a lesser extent L4-L5, which is associated with minimal dorsal indentations of the thecal sac. This compatible with Baastrup disease.T12-L1, L1-L2, L2-L3: There is no significant disc herniation. There is no spinal canal or foraminal stenosis. There is mild thickening of ligamenta flava.L3-4: Minimal disc bulge is present along with moderate ligamentum flavum thickening. There is no significant spinal canal or foraminal stenosis.L4-L5: Minimal disc bulge and moderate ligamentum flavum thickening present without significant spinal canal or foraminal stenoses.L5-S1: There is no significant spinal canal or foraminal stenosis. There is moderate right and mild left facet arthropathy associated with increased contrast enhancement.There are typical changes are present at the sacroiliac joints with subchondral sclerosis and articular surface irregularity as well as marginal osteophytes/syndesmophytes. There is T1 hypointensity with more linear configuration in the right sacral ala with surrounding ill-defined abnormal signal, which may reflect a nondisplaced insufficiency fracture. Similar change is present also in the adjacent right iliac bone.
1.Bilateral sacroiliac joint osteoarthritic changes are present. Additional T1 hypointensity including in a more linear configuration in the right sacral ala and possible in adjacent right iliac bone which could reflect a nondisplaced insufficiency fracture. Please correlate clinically. MR of the sacrum could be obtained for further evaluation.2.There is no spinal cord abnormality to suggest demyelinating disease. No MR evidence of spinal tumor as clinically questioned.3.Reactive inflammatory change in the interspinous spaces of L3-L4 and L4-L5, which could indicate Baastrup disease. Inflammatory degenerative changes are also present at the L5-S1 facets, right more than left. These findings can contribute to back pain.4.Moderate-to-severe lower cervical spinal canal stenosis with mass-effect on the spinal cord. Please refer to the report on the cervical spine MRI from the day prior for more details.5.Incidental dilated extrahepatic bile ducts but no gallbladder dilatation. Please correlate with cholestatic laboratory parameters and potentially dedicated hepatobiliary imaging. 