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    Old 04-14-2015, 06:49 AM   #1
    clevelandgal
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    Help understanding test results!

    Hi!! I am a bit overwhelmed and could use some help I am a 35 year old female...I have been going to the doctor for thoracic back pain since March 1st..I have been through what feels like 5 different diagnosis since then and still no answers..they have ruled out osteoporosis and all blood work is normal... The scans showing different results...I have a chest and spine MRI with contrast schedule for next week...so my questions are...what illnesses appear like degeneration and scoliosis on xray but show as lesions on MRI? Also, what type of nerve tumors or cysts show up in multiple locations? The ones I have researched seem to normally show up singularly. Here are my xray and MRI findings.


    Xray Results:

    RESULT:Moderate dextro curve centered at T10. Spondylosis with disc space
    narrowing C5-C7 mild grade 1 degenerative spondylolisthesis C5-6. Mild
    endplate deformities T8-T10 is suggestive of osteopenia that is
    disproportionate for age and may be related to risk factors such as
    medication. No compression fractures. Surgical clips present in the right
    upper quadrant
    IMPRESSION: ENDPLATE DEFORMITIES OF THE LOWER THORACIC VERTEBRAE AS
    DETAILED ABOVE SUGGEST ENDPLATE FRACTURES DISPROPORTIONATE FOR AGE AND
    MAY BE RELATED TO OSTEOPENIA INDUCING MEDICATION OR AN UNDERLYING
    SYSTEMIC DISORDER. DEGENERATIVE CHANGES DISPROPORTIONATE FOR AGE IN THE
    PARTIALLY DEMONSTRATED LOWER CERVICAL SPINE.

    MRI without contrast

    MR THORACIC:

    Counting reference: Lumbosacral junction. For the purposes of this
    report, L4-5 is considered the level of the iliac crest.

    Alignment: Alignment is anatomic.

    Cord: The visualized cord is within normal limits of signal intensity
    and morphology.

    Bone marrow signal/fracture: No evidence of pathologic marrow
    infiltration. No evidence of prior fracture.

    Thoracic soft tissues: Tiny high T2 signal lesions measuring up to 6 mm
    within bilateral neural foramina at C7-T1 left neural foramen at T1-T2
    left neural foramen at T2-T3 and left neuroforamen at T7-T8 T8-T9 and
    T9-T10 and T10-T11 and T11-T12 and T12-L1 and within right neural
    foramina at T7-T8 and T8-T9 and T9-T10 and T10-T11 at T11-T12. Tiny
    likely similar lesions are demonstrated within the lower cervical spine
    on the scout images 1.1 x 0.8 cm cystic lesion inferior to the right
    posterior fourth rib. Similar 1.1 x 0.7 cm cystic lesion demonstrated
    inferior to the left posterior fifth and bilateral posterior sixth ribs.
    Paraspinal soft tissues are within normal limits.

    Canal and foramina: The thoracic canal and foramina are patent.
    IMPRESSION:

    NO CANAL OR FORAMINAL STENOSIS. NO DEFINITE EVIDENCE OF FRACTURE.

    THERE ARE NUMEROUS HIGH T2 SIGNAL LESIONS WITHIN THE FORAMINA AND
    ADJACENT TO MULTIPLE POSTERIOR RIBS WHICH COULD REPRESENT NERVE SHEATH
    TUMORS OR PERINEURAL CYSTS. CONTRAST-ENHANCED IMAGING OF THE THORACIC
    SPINE AND LIKELY CHEST ADVISED.

     
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    Old 04-14-2015, 07:44 AM   #2
    teteri66
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    Re: Help understanding test results!

    Have your doctors ruled out Tarlov cysts? They are fluid filled cysts that form around the nerve sheath and are mostly thought to be asymptomatic. They are most common in the sacral area, then the lumbar area, and rarely in thoracic or cervical...but, they do occur there, too.

    Oh, just reread the report and it does suggest the possibility of perineural cysts (another name for Tarlov cysts).

    Do you have osteopenia? What surgery did you have?

    I have my weekly acupuncture appointment in a few minutes, so must stop for now. If no one has commented on your MRI, I will later today.

    http://www.ninds.nih.gov/disorders/tarlov_cysts/tarlov_cysts.htm

    Last edited by teteri66; 04-14-2015 at 07:54 AM.

     
    Old 04-14-2015, 07:57 AM   #3
    clevelandgal
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    Re: Help understanding test results!

    Hi!! They ruled out osteopenia...my bone scan was normal... I was reading on those cysts you mentioned but the fact they dont normally cause pain didn't seem to add up...I have severe pain...I can't bend much or stand or walk for long periods ..I am normally very active with yoga and chasing young kids so this has thrown me off so much!!

     
    Old 04-14-2015, 11:03 AM   #4
    teteri66
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    Re: Help understanding test results!

    What type of doctors have you seen?

     
    Old 04-14-2015, 11:12 AM   #5
    clevelandgal
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    Re: Help understanding test results!

    Quote:
    Originally Posted by teteri66 View Post
    What type of doctors have you seen?
    So far just my family doc...was supposed to see an orthopedic doc today but family doc had me cancel it once the first MRI ruled out any bone issues...I have an appointment with a rheumatologist in May and the family doctor said I will likely need to see a neurosurgeon after we do the contrast MRIs... All of my docs are with the Cleveland Clinic so hopefully I can get some answers soon...my family doc is purposefully being vague since she says she wants to see all of the test results before acting on it...just hard as a patient to wait!!

     
    Old 04-14-2015, 02:54 PM   #6
    teteri66
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    Re: Help understanding test results!

    You might want to make an appointment with an orthopedic spine surgeon, particularly after you get all the spine MRIs back. This specialty, as well as a neurosurgeon who limits his practice to the neck and back, are the two specialties that can be considered spine specialists, who have the most training and experience in the mechanics and diseases of the spine.

    A PCP or family doctor would have almost no experience with Tarloc cysts. As a matter of fact, many spine specialists have limited knowledge and will often tell patients that they could not be a pain generator. Also, all bone issues have not been ruled out.

    Your report reveals several unusual findings that were sufficiently odd that the radiologist could not identify them. One is the cysts, which are suggested to possibly be perineural cysts, another name for Tarlov cysts. A second finding is the endplate damage in the lower vertebrae of the thoracic spine which the radiologist says is very unusual for someone your age. That same comment is made regarding the degenerative changes in part of the cervical spine, again which is a surprise finding for someone your age.

    You ask what illnesses appear like degeneration or scoliosis on x-ray....these findings would be the same on MRI: There is a slight curve of the thoracic spine, off to the left that is centered around the T10 vertebra. There is a Grade I spondylolisthesis at C5-6. This is a situation that can be congenital, idiopathic or degenerative, where one vertebra slips over the top of the adjacent one. This can be or can develop into a source of instability if the slippage is "active." It is something that should be watched as it can continue to slip. Grade I is the mildest or smallest amount, 1-25%, and usually does not require surgery if it is not "pinching" any spinal nerves. Since this is not mentioned, I would assume yours is causing no spinal nerve compression, or at least not enough to visualize on the MRI.

    Other than the endplate issues and the cysts or lesions, the MRI of the thoracic spine is normal. There are no apparent fractures, no stenosis in the central canal or foramen, although the lesions are apparently located in some of the foramen. This is not mentioned in the report, but if the lesions grow, it will result in less space in the foramen, which leads to spinal nerve irritation or compression. It is probably this factor that is causing the pain you feel when standing long or walking a bit, or when bending at the waist.

    The radiologist suggests you get a MRI with contrast that will hopefully help to diagnose some of these issues.

     
    Old 04-14-2015, 03:11 PM   #7
    clevelandgal
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    Re: Help understanding test results!

    Quote:
    Originally Posted by teteri66 View Post
    You might want to make an appointment with an orthopedic spine surgeon, particularly after you get all the spine MRIs back. This specialty, as well as a neurosurgeon who limits his practice to the neck and back, are the two specialties that can be considered spine specialists, who have the most training and experience in the mechanics and diseases of the spine.

    A PCP or family doctor would have almost no experience with Tarloc cysts. As a matter of fact, many spine specialists have limited knowledge and will often tell patients that they could not be a pain generator. Also, all bone issues have not been ruled out.

    Your report reveals several unusual findings that were sufficiently odd that the radiologist could not identify them. One is the cysts, which are suggested to possibly be perineural cysts, another name for Tarlov cysts. A second finding is the endplate damage in the lower vertebrae of the thoracic spine which the radiologist says is very unusual for someone your age. That same comment is made regarding the degenerative changes in part of the cervical spine, again which is a surprise finding for someone your age.

    You ask what illnesses appear like degeneration or scoliosis on x-ray....these findings would be the same on MRI: There is a slight curve of the thoracic spine, off to the left that is centered around the T10 vertebra. There is a Grade I spondylolisthesis at C5-6. This is a situation that can be congenital, idiopathic or degenerative, where one vertebra slips over the top of the adjacent one. This can be or can develop into a source of instability if the slippage is "active." It is something that should be watched as it can continue to slip. Grade I is the mildest or smallest amount, 1-25%, and usually does not require surgery if it is not "pinching" any spinal nerves. Since this is not mentioned, I would assume yours is causing no spinal nerve compression, or at least not enough to visualize on the MRI.

    Other than the endplate issues and the cysts or lesions, the MRI of the thoracic spine is normal. There are no apparent fractures, no stenosis in the central canal or foramen, although the lesions are apparently located in some of the foramen. This is not mentioned in the report, but if the lesions grow, it will result in less space in the foramen, which leads to spinal nerve irritation or compression. It is probably this factor that is causing the pain you feel when standing long or walking a bit, or when bending at the waist.

    The radiologist suggests you get a MRI with contrast that will hopefully help to diagnose some of these issues.
    Thanks! I thought it strange that the mri made no mention of the curve... Also guessing what looked like degeneration on the xray was probably the lesions...just so nerve wracking waiting for tests and appointments!! I have been reading up on Tarlov cysts since you mentioned it...do they often do surgical excision on these? I am on so much pain now I dread thinking they will me there aren't good treatment options for me...thanks for taking the time!

     
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