Clinical question: Evaluate for osteomyelitis. Patient has GPC bacteremia. Signs and symptoms: Back pain. Nonenhanced complete spine MRI: Cervical spine demonstrate normal anatomic alignment the vertebral column and unremarkable signal intensity. There is no finding on this nonenhanced study to suggest presence of an inflammatory/infectious process.Foramen magnum is unremarkable.C2 -- C3 and the straight moderate disk disease and moderate to significant bilateral ligamentum flavum hypertrophy. There is resultant moderate central spinal stenosis and mild left neural foraminal compromise.C3 -- C4 demonstrate moderate disk disease and loss of disk height, significant bilateral ligamentum flavum hypertrophy and mild facet disease. Constellation of changes results in significant central spinal stenosis and moderate bilateral neural foraminal compromise. Tiny focus of flair hyperintensity within the cord on the right (sagittal T2 stir image 8 and axial T2 series 801 image 18) highly suspected of myelomalacia.C4 -- C5 demonstrate moderate disk disease and loss of disk height, shallow broad-based bulging disk and moderate bilateral ligamentum flavum hypertrophy. Constellation of changes results in mild central spinal stenosis and significant bilateral neural foraminal compromise. Punctate foci of T2 hyperintensity in the dorsal aspect of the cord suspicious for myelomalacia.C5 -- C6 demonstrate advanced disk disease, loss of disk height, mild bilateral facet and moderate bilateral ligamentum flavum hypertrophy. Constellation of changes results in moderate central spinal stenosis and significant bilateral neural foraminal compromise.C6 -- C7 demonstrate advanced disk disease and loss of disk height moderate bilateral ligamentum flavum hypertrophy and mild facet disease. Constellation of changes results in moderate central spinal stenosis and significant left and moderate right neural foraminal compromise.C7 -- T1 is unremarkable.Nonenhanced thoracic MRI:Although nonenhanced this examination demonstrate no findings to suggest presence of an infectious or inflammatory process.The alignment of the vertebral column is anatomical. There is however exaggerated kyphosis of the thoracic spine. There is a chronic approximately 50% compression deformity of T7 vertebrae without malalignment. No evidence of any additional fractures.No evidence of central spinal stenosis at any level. Normal signal intensity and caliber of thoracic cord. No significant neural foraminal compromise.No detectable paraspinal soft tissue abnormalities.Incidental note is made of multiple bilateral (left greater than right) renal cysts of varying size. The largest visualized cyst on the left measures approximately 35 mm in transverse axis. Examination also demonstrate small bilateral pleural effusion measuring at 6-mm on the left and 2.5-mm on the right.Nonenhanced lumber spine:The alignment the vertebral column is anatomical.There is increased T2 signal intensity of the intervertebral disk space at L5 -- S1 level. There is no adjacent endplate or vertebral body signal abnormality and no detectable paraspinal or epidural associated abnormality. Finding could represent effusion in the disk space however possibility of overlapping infectious process cannot be entirely excluded and follow-up with enhanced imaging of the lumbar spine is recommended.T12 -- L1 demonstrate moderate disk disease and loss of disk height, mild to moderate bilateral ligamentum flavum and facet hypertrophy. Findings results in mild central spinal stenosis and no neural foraminal compromise.L1 --L2 demonstrate moderate disk disease and loss of disk height, mild bilateral facet and ligamentum flavum hypertrophy. Mild central spinal stenosis and bilateral neural foraminal compromiseL2 -- L3 demonstrate mild disk desiccation along moderate bilateral ligamentum flavum hypertrophy and a lesser degree of bilateral facet hypertrophy. Changes results in mild central spinal stenosis and mild bilateral neural foraminal compromise.L3 -- L4 demonstrate mild disk desiccation, significant left and moderate right ligamentum flavum hypertrophy and mild bilateral facet disease. Constellation of above findings results in moderate central spinal stenosis and moderate ( left greater than right) neural foraminal compromise.L4 -- L5 demonstrate mild disk disease and significant (left greater than right) ligamentum flavum hypertrophy and mild facet disease. There is resultant moderate central spinal stenosis and moderate bilateral neural foraminal compromise.L5 -- S1 demonstrate moderate disk disease and loss of disk height, significant bilateral ligamentum flavum hypertrophy and resultant mild central spinal stenosis. Significant bilateral (left greater than right) neural foraminal compromise is present.
1.Nonenhanced MRI of the cervical spine demonstrate no findings to suggest presence of an infectious or inflammatory process. Extensive degenerative disk disease and hypertrophic changes of posterior elements (in particular of the ligamentum flavum) results in central spinal stenosis at C2 -- C3 through C6 -- C7 levels of varying degrees. There are also bilateral neural foraminal compromise (many significantly) throughout the cervical spine as detailed per level above. Small foci of cord myelomalacia at C3 -- C4 and C4 -- C5 levels.2.Nonenhanced MRI of thoracic spine demonstrate no finding to suggest presence of an infectious or inflammatory process. Normal signal intensity and caliber of thoracic cord. No evidence of central spinal stenosis or any significant neural foraminal compromise. Approximately 50% chronic compression fracture of T7 and exaggeration of thoracic kyphosis is noted. Small bilateral pleural effusions and multiple bilateral renal single likely cysts as detailed/measured above.3.Nonenhanced MRI of lumbar spine demonstrate increased T2/T2 stir signal intensity of the disk space at L5 -- S1 level without any associated other findings to suggest an infectious process, however to entirely exclude this possibility follow up with post enhanced imaging is recommended. Examination in addition demonstrate varying degrees of degenerative disk disease and moderate to significant ligamentum flavum hypertrophy throughout the study. Findings results in central spinal stenosis of varying degrees at T12 -- L1, L2 -- L3, L3 -- L4, L4 -- L5 and L5 -- S1 levels as detailed. Multilevel bilateral neural foraminal compromise of varying degrees is also present as detailed per level above.