43-year-old male with history of chronic bilateral back pain and leg pain. Evaluate for possible abscess versus disc disease. Please note this study is technically limited. Five lumbar type vertebral bodies are presumed to be present for the purposes of numbering. Vertebral body heights are within normal limits. There is loss of disc height at L3-4, L4-5, and most severely at L5-S1. There is abnormal T2 signal within the L4-5 and L5-S1 disc space. There are suspected inflammatory changes in the paraspinous soft tissues at L4-5 and L5-S1 raising suspicion for infection. There is a tiny T2 hyperintense lesion in the right psoas muscle which could represent a small abscess. There are endplate marrow signal changes at L4-5 and L5-S1 which are difficult to evaluate due to artifact. There is diffuse low T1 signal in the marrow which may be related to chronic anemia. The conus medullaris is normal in position terminating at L1. Alignment is within normal limits. Innumerable bilateral renal cysts are present compatible with end-stage renal disease.Multilevel degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: Mild disc bulge with no significant spinal canal or neuroforaminal stenosis. Moderate facet hypertrophy.L3-L4: Mild disc bulge with left paracentral disc protrusion which results in mild to moderate left neuroforaminal narrowing. No significant spinal canal stenosis. Moderate facet hypertrophy.L4-L5: There is near complete loss of disc height especially along the right aspect of the disc. There is a mild left paracentral disc protrusion resulting in mild to moderate left neuroforaminal stenosis and mild right foraminal stenosis. No significant spinal canal stenosis. Moderate facet hypertrophy.L5-S1: There is near complete diffuse loss of disc height. Mild bilateral neuroforaminal narrowing. No significant spinal canal stenosis. Moderate facet hypertrophy. Bilateral facet effusions.
1. Study is technically degraded due to artifacts and poor signal. There is abnormal T2 hyperintense signal within the L4-5 and L5-S1 disc space. There are mild inflammatory changes suspected in the paraspinous soft tissues at L4-5 and L5-S1 raising suspicion for infection. There is a tiny T2 hyperintense lesion in the right psoas muscle (axial T2 image 7/50 series 601) which could represent a small abscess. No epidural collections. As patient can not receive gadolinium, recommend repeat MRI spine study with conventional sequences, axial T2 fatsat, and diffusion. CT lumbar spine with contrast can also be considered.2. Multilevel degenerative disc disease with near complete loss of disc height at L4-5 and L5-S1 which may be related to degenerative disease versus infection. There are endplate marrow changes which are difficult to evaluate due to artifact. 3. No significant spinal canal stenosis. Mild to moderate left L4-5 and L5-S1 neural foraminal stenosis.4. Multilevel facet arthropathy especially at L5-S1.5. Diffuse low T1 marrow signal which is nonspecific and can be seen in conditions such as chronic anemia.Findings including recommendation for repeat study were discussed with Dr. Garza at 1600 hrs on 2/28/2015.