The Adventures of RedRandy: The Adventure of the MRI

Magnetic Resonance Imaging (MRI) of the lumbar spine without contrast

PATIENT HISTORY: Chronic bi-laterally low back pain with left lateral ankle/foot numbness.

TECHNIQUE: A noncontrast MR of the lumbar spine was performed in standard institutional protocol.

FINDINGS:
The conus medullaris ends at the L1 vertebral body level.
The spinal cord and cauda equina are within normal limits in signal and contour.
There is multilevel degenerative disc disease.
Diffuse red marrow hyperplasia.
Small hemangioma vs focus of fatty marrow in L4.
There is a normal lordotic curvature of the lumbar spine.
There is a tiny Grade I retrolisthesis of L3 over L4 which is likely degenerative.
There is no evidence of compression fracture.

L1-L2: There is a mild diffuse disc bulge with no spinal canal stenosis. There is facet arthropathy. There is minimal narrowing of the left neural foramen. The right neural foramen is patent and within normal limits.

L2-L3: There is a diffuse disc bulge with no significant spinal canal stenosis. There is facet arthropathy. There is mild neuroforaminal narrowing bilaterally.

L3-L4: There is a diffuse disc bulge with no significant spinal canal stenosis. There is facet arthropathy. There is mild neuroforaminal narrowing bilaterally.

L4-L5: There is a diffuse disc bulge with no significant spinal canal stenosis. There is facet arthropathy with ligamenrum flavum hypertrophy. There is mild neuroforaminal narrowing bilaterally.

L5-S1: There is no disc bulge. The there is no spinal canal stenosis. Bilateral neuroforamina are patent and within nonnallimits.

IMPRESSION:
Diffuse degenerative changes as described above with no significant spinal canal stenosis.

Multilevel mild neuroforaminal narrowing as described above.

Red marrow hyperplasia. Is the patient anemic? Good question...

DEFINITIONS: (source Wikipedia.com)

Stenosis is an abnormal narrowing in a blood vessel or other tubular organ or structure.)

What does neuroforaminal narrowing mean? A: It is a constricted opening that nerves pass through

The conus medullaris is the terminal end of the spinal cord. It occurs near lumbar nerves (L1) and (L2). After the spinal cord terminates, the spinal nerves continue as dangling NERVE ROOTS (not nerves as nerves are part of the PNS) called the cauda equina.

A hemangioma is a congenital benign tumor or vascular malformation of endothelial cells (the cells that line blood vessels).

An arthropathy is a disease of a joint.

A retrolisthesis is a posterior displacement of one vertebral body with respect to the adjacent vertebrae to a degree less than a luxation.

Diffuse - spontaneous dispersion of mass

Marrow types - There are two types of bone marrow: red marrow (consisting mainly of myeloid tissue) and yellow marrow (consisting mainly of fat cells). Red blood cells, platelets and most white blood cells arise in red marrow; some white blood cells develop in yellow marrow. Both types of bone marrow contain numerous blood vessels and capillaries. At birth, all bone marrow is red. With age, more and more of it is converted to the yellow type. About half of the bone marrow is red. Red marrow is found mainly in the flat bones, such as the hip bone, breast bone, skull, ribs, vertebrae and shoulder blades, and in the cancellous ("spongy") material at the epiphyseal ends of the long bones such as the femur and humerus. Yellow marrow is found in the hollow interior of the middle portion of long bones. In cases of severe blood loss, the body can convert yellow marrow back to red marrow to increase blood cell production.

Hyperplasia (or "hypergenesis") is a general term referring to the proliferation of cells within an organ or tissue beyond that which is ordinarily seen. The MR imaging appearance of the bone marrow depends on the presence and relative proportions of trabecular bone, fat, and water. Each of these constituents of the bone marrow produces a different MR signal. It is the summation of these signals that creates the final MR image. Because the bone marrow is a dynamic organ that changes continuously from birth through life, the MR appearance of the bone marrow varies with age. The predictable rate and patterns of red (hematopoietic) to yellow (fatty) marrow conversion and the unique characteristics of red and yellow marrow on MR images have allowed for the mapping of their age-related distributions in the skeleton. In some situations, yellow marrow may be converted into red marrow and this process is called marrow reconversion.

What Is Anemia? Anemia is a condition that develops when your blood lacks enough healthy red blood cells. These cells are the main transporters of oxygen to organs. Because a low red blood cell count decreases oxygen delivery to every tissue in the body, anemia may cause many signs and symptoms. It can also make almost any other underlying medical condition worse. If anemia is mild, it may not cause any symptoms. If anemia is slowly ongoing (chronic), the body may adapt and compensate for the change; in this case there may not be any symptoms until the anemia becomes more severe.