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What Does My MRI Report Suggest?

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Posted on Mon, 7 Apr 2014
Question: Can you please give me your opinion on this MRI result? They initially were worried about scoliosis or a herniated disk. Now they are sending me to a hemotologist to rule out leukemia and blood disorders, because they are concerned about the findings in the last paragraph. I have no clue what any of this means and now I don't know what's going on with my back or why they are concerned? I do have osteoarthritis in my hip, but I don't know if that had went to my back. I'm thinking it would have showed. Please shed some light. .. Google is not helping this time. .. Thanks Findings: Mild developmental narrowing of the mid to lower lumbar spinal cabal the significance of which is to accentuate disc pathology and associated spondylosis. No evidence for intraspinal mass lesions or focal abnormalities of the cord. Evaluation of the disc spaces reveal mild or early degenerative disc narrowing noted at L2-3 and L3-4 but without evidence for significant disc protrusion or evidence for herniations. The lower lumbar disc spaces are unremarkable in their appearance. There is evidence of mild hypertrophic degenerative changes noted at the L4-5 and L5-S1 facet joints bilaterally but the findings are not associated with significant stenosis of the lateral recesses or of the foramina. The rest of the visualized posterior elements and intervertebral foramina are otherwise unremarkable. There is noted a mild generalized abnormal marrow signal pattern seen throughout the lumbar and upper sacral vertebra. This is best appreciated as a hypointense appearance on the T1 weighted images. This is not associated with deformity in the contour of the vertebra. Although this may be physiologic in nature, an early or subtle myeloproliferative disorder cannot be excluded.
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Answered by Dr. Vinay Bhardwaj (17 hours later)
Brief Answer: Results need to be followed up on, but dont worry! Detailed Answer: Hi XXXXXXX My name is Vinay. Let me see if I can give you some basic information and help you understand whats going on with this scan. That should help you understand what they are up too. I have gone through the findings that you have entered above and I will try and translate them line by line. "Mild developmental narrowing of the mid to lower lumbar spinal cabal the significance of which is to accentuate disc pathology and associated spondylosis." What they are saying here is that the Radiologist has compared the size of your Spinal Canal in your Lower Back (Lumbar Region) to other people (s)he has seen and they believe that the canal has been narrow from birth. There's not much that can be done about what you were born with but they do add that this will probably make any existing disc or vertebral problems in this area worse than they would be in other people. "Evaluation of the disc spaces reveal mild or early degenerative disc narrowing noted at L2-3 and L3-4 but without evidence for significant disc protrusion or evidence for herniations." Here what they are saying is that they have noticed age-related changes in 2 of the discs in your lumbar region. Unfortunately that happens to us all and the only way to slow the process is core strengthening, making sure we don't develop osteoporosis and maintaining a healthy weight. "There is evidence of mild hypertrophic degenerative changes noted at the L4-5 and L5-S1 facet joints bilaterally but the findings are not associated with significant stenosis of the lateral recesses or of the foramina" Here, they have said they have noticed some inflammation of the joints connecting these two vertebrae. It's almost like an arthritis of those joints. They say it's mild. I would tend to believe them, but i can't confirm that without seeing the scan myself. Also, again, alot of the time we really can't avoid these kinds of things. And now on to the thing that is probably worrying you the most "There is noted a mild generalized abnormal marrow signal pattern seen throughout the lumbar and upper sacral vertebra. This is best appreciated as a hypointense appearance on the T1 weighted images. This is not associated with deformity in the contour of the vertebra. Although this may be physiologic in nature, an early or subtle myeloproliferative disorder cannot be excluded." So an MRI is pretty amazing tech. You get to see soft tissues deep inside the body and it generally gives you a very good picture. But it's not perfect, and when it comes to seeing this like bone marrow on the inside of the bone, sometimes it can be tricky to interpret. The Radiologist is seeing an alteration of the signals coming out of the Marrow in the tail-bone region of your spine. The altered signals don't seem to show that the bone has been affected (so there doesn't seem to be a tumor or anything pushing against, or eating at, the bone there). What they are saying is that such a signal change CAN be normal and that they have seen it in normal people before... BUT THEY CAN'T BE SURE. Well that's a Radiologist for ya. They only report what they see, they don't know about the patient or the history or much of anything else. So now your Primary doctor is sort of duty bound to MAKE SURE that there is nothing wrong with the marrow in that region. So who can they send you to who is an expert when it comes to Bone Marrow (the stuff that makes the cells in your blood)? A hematologist! They are experts at either ruling IN a blood disorder or ruling it OUT all together. Now. If I saw this report, I wouldn't be to worried.. BUT I'd still send you to the Hematologist to rule out any of the bad stuff like leukemia. I'd hate to miss something like that because MOST of the time it turns out to be nothing. So what we have here is most likely a bit of a detour on the way to figuring out whats wrong with your lower back. My educated guess is that the Hematologist will order a few follow up tests and clear you of any nastiness and send you back to your PRIMARY for further workup. I noted that you have Osteoporosis of the HIP. That doesn't look like this in the spine, so don't worry about that. Just make sure you are following up with your doctor and managing the condition regularly. A fractured hip is a horrible thing to have. So to sum up? Your scan shows mostly developmental and age related changes of the lumbar spinal column that can be seen in millions of healthy and asymptomatic people and the radiologist was a bit iffy about the marrow in that one particular part of the column. I hope this helps. Feel free to follow-up with me or ask anything else you would like and thanks for coming to HealthCareMagic.Com. Take care.
Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
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Follow up: Dr. Vinay Bhardwaj (10 hours later)
My other doc called with my routine blood results. High white blood cells and protein. She said to get into a hemotologist/oncologist right away. Also I have had stomach issues for years. They found an enlarged spleen and fatty liver on an ultrasound about 9 years ago when I went to a walk in clinic for stomach issues. I had gastritis a couple years ago and now I have to take a pill everyday or my stomach hurts horribly. On top of that my hair comes out excessively and I am usually the one who is sick in the house, every few weeks. I'm really hoping these things are coincidental but I'm starting to worry. Do you think they could be related?
doctor
Answered by Dr. Vinay Bhardwaj (6 hours later)
Brief Answer: Concerning, but very general. Detailed Answer: Hi XXXXXXX Thanks for following up with me. The constellation of symptoms that you have mentioned would definitely "fit" a diagnosis like that. But the whole problem with these kinds of diseases that their symptoms are so generalized and can happen in pretty much any order of appearance. The enlarged spleen is concerning, but 9 years! That's a really long time to have symptoms of Leukemia (if it IS Leukemia) and the disease not progressing to a more aggressive and obvious form. God forbid there really is any form of leukemia or amyloidosis, it would probably be a very slow form of the disease given the timeline. Hairloss is again really really generalized and tough to pin down to any one problem. Your gastritis issues again, are pretty common. Lots of people suffer from Acid Peptic disorders so I am loath to say its because of cancer. I am glad you are going to the Hematologist. It will be the definitive way to rule this disease 'out'. I do dearly hope that we don't end up ruling it 'in'. Let me know what happens. Follow-up with me whenever you want and upload your results. I will do my best to talk you through them. Take care and Thanks for coming to HealthCareMagic.com
Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
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Dr. Vinay Bhardwaj

Neurologist, Surgical

Practicing since :2006

Answered : 544 Questions

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What Does My MRI Report Suggest?

Brief Answer: Results need to be followed up on, but dont worry! Detailed Answer: Hi XXXXXXX My name is Vinay. Let me see if I can give you some basic information and help you understand whats going on with this scan. That should help you understand what they are up too. I have gone through the findings that you have entered above and I will try and translate them line by line. "Mild developmental narrowing of the mid to lower lumbar spinal cabal the significance of which is to accentuate disc pathology and associated spondylosis." What they are saying here is that the Radiologist has compared the size of your Spinal Canal in your Lower Back (Lumbar Region) to other people (s)he has seen and they believe that the canal has been narrow from birth. There's not much that can be done about what you were born with but they do add that this will probably make any existing disc or vertebral problems in this area worse than they would be in other people. "Evaluation of the disc spaces reveal mild or early degenerative disc narrowing noted at L2-3 and L3-4 but without evidence for significant disc protrusion or evidence for herniations." Here what they are saying is that they have noticed age-related changes in 2 of the discs in your lumbar region. Unfortunately that happens to us all and the only way to slow the process is core strengthening, making sure we don't develop osteoporosis and maintaining a healthy weight. "There is evidence of mild hypertrophic degenerative changes noted at the L4-5 and L5-S1 facet joints bilaterally but the findings are not associated with significant stenosis of the lateral recesses or of the foramina" Here, they have said they have noticed some inflammation of the joints connecting these two vertebrae. It's almost like an arthritis of those joints. They say it's mild. I would tend to believe them, but i can't confirm that without seeing the scan myself. Also, again, alot of the time we really can't avoid these kinds of things. And now on to the thing that is probably worrying you the most "There is noted a mild generalized abnormal marrow signal pattern seen throughout the lumbar and upper sacral vertebra. This is best appreciated as a hypointense appearance on the T1 weighted images. This is not associated with deformity in the contour of the vertebra. Although this may be physiologic in nature, an early or subtle myeloproliferative disorder cannot be excluded." So an MRI is pretty amazing tech. You get to see soft tissues deep inside the body and it generally gives you a very good picture. But it's not perfect, and when it comes to seeing this like bone marrow on the inside of the bone, sometimes it can be tricky to interpret. The Radiologist is seeing an alteration of the signals coming out of the Marrow in the tail-bone region of your spine. The altered signals don't seem to show that the bone has been affected (so there doesn't seem to be a tumor or anything pushing against, or eating at, the bone there). What they are saying is that such a signal change CAN be normal and that they have seen it in normal people before... BUT THEY CAN'T BE SURE. Well that's a Radiologist for ya. They only report what they see, they don't know about the patient or the history or much of anything else. So now your Primary doctor is sort of duty bound to MAKE SURE that there is nothing wrong with the marrow in that region. So who can they send you to who is an expert when it comes to Bone Marrow (the stuff that makes the cells in your blood)? A hematologist! They are experts at either ruling IN a blood disorder or ruling it OUT all together. Now. If I saw this report, I wouldn't be to worried.. BUT I'd still send you to the Hematologist to rule out any of the bad stuff like leukemia. I'd hate to miss something like that because MOST of the time it turns out to be nothing. So what we have here is most likely a bit of a detour on the way to figuring out whats wrong with your lower back. My educated guess is that the Hematologist will order a few follow up tests and clear you of any nastiness and send you back to your PRIMARY for further workup. I noted that you have Osteoporosis of the HIP. That doesn't look like this in the spine, so don't worry about that. Just make sure you are following up with your doctor and managing the condition regularly. A fractured hip is a horrible thing to have. So to sum up? Your scan shows mostly developmental and age related changes of the lumbar spinal column that can be seen in millions of healthy and asymptomatic people and the radiologist was a bit iffy about the marrow in that one particular part of the column. I hope this helps. Feel free to follow-up with me or ask anything else you would like and thanks for coming to HealthCareMagic.Com. Take care.