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    Old 08-11-2013, 09:48 AM   #1
    phianthus
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    Unhappy Please help me understand my mri

    HI I just got my MRI back and it has me worried, i dont want more surgery as i am already in treatment for metastatic papillary thyroid carcinoma.

    here is the findings of my mri:

    the disks are diffusely dessicated with associated loss of height which is most pronounced at the levels of c4-C5 through C6-C7 a moderate to large dregree of nonspecific edema is seen involving the vertebral bodies and endplates at th level of C5-C6. This is seen to a lesser extent at the level of C4-C5. Small to moderate sized osteophytes are seen most prounounced at C4-C5. There is probabable mild anterior wedging at the levels of C4-T1. MIld Bulge and anteriosthesis is sen at the level of T1-T2. No definate signal abnormalities are seen within the cord serial axial images were obtained from the level of C1-S1.

    C1-C2- There is no evidence of significant central stenosis
    C2-C3 - There is no evidence of focal disk herniation, central stenosis or neural foramina narowing

    C3-C4 - MIld Disk osteophyte complex is seen. MIld BUlge is present. There is mild effacement of the thecal sac anteriorly. probabable mild central stenosis is seen. The midline AP diameter of the thecal sac is approximately 1cm. probable moderate neural foraminal narrowing is seen on the right. No definate neural foraminal narrowing is seen on the left.

    C4-C5 - Disk Osteophyte complex is seen. Broad based disc bulge is seen. There is probable mild flattening of the cord. The AP midline diameter of the thecal sac measures approximatly 8 mm. Probable mild to moderate central stenosis is seen. Probable severe neural foraminal narrowing is seen on the right. Probable moderate to severe neural foraminal narrowing is seen on the left. Probable mild to moderate hypertrophic changes are seen involving the unconvertabral joints. MIld retrolethesis is seen.

    C5-C6 -Disk osteophyte complex is seen at this level. broad based Bulge is seen. There is flattening of the cord. probable moderate central stenosis is seen. Midline AP diameter of thr thecal sac measures approximatly 6 mm. Probable severe neural foraminal narrowing is seen on the left. Probable moderate to severe neural foraminal narrowing is seen on the right. Probable mild to moderate hypertrophic changes are seen involving the unconvertabral joints. MIld retrolethesis is seen.

    C6-C7 Disk Osteophyte complex is seen at this level. Broad based disc bulge is present. probable flattening of the cord is seen. Probable mild to moderate central stenosis is seen. he midline AP diameter of the thecal sac is approximatly 8 mm. Probable moderate neural foraminal narrowing is seen on the right. Probable moderate to severe neural foraminal narrowing is seen on th left. MIld to moderate hypertrophic changes are seen involving the uncovertabral joints.

    C7-T1 - MIld bulge is seen at this level. MIld antereolisthesis is seen. Probable mild neural foraminal narrowing is sen on the left. No definate neural foraminal narrowing is seen on the right.

    Impression:
    1 Multilevel disk disease as described above most prominant at the levels of C4-C5 through C6-C7. There is multilevel mild to moderate Central stenosis And moderate to severe neural foraminal narowing as described above.

    2. Moderate to large drgree of nonspecific edema seen on the stir sequence involving the vertabral bodies and endplates at the level of C5-C6, and to lesser extent C4-C5. There is no evidence of corresponding edema within the intervening disks. The sequela of aggressive degenerative changes is favored given the constellation of findings. Consider followup study

    Thoracic Spine:
    The tip of the conus medullaris is at approximately L1. The images reveal normal alignment of the thoracic vertebra. Mild chronic wedging of the superior endplate of T11. Height of the remaining vertebra is normal. Bone marrow signal is normal. Multilevel disc space narrowing and disc desiccation. There is no abnormal signal with the thoracic spinal cord. No definite significant spinal canal or foraminal stenosis is noted. Axial images demonstrate a left paracentral disc protrusion at T6/T7.. A larger left paracentral disc protrusion demonstrated at T7/T8. Right paracentral disc protrusion at T8/T9 indenting the ventral thecal sac. Bilateral paracentral disc protrusions at T9/T10.

    The visualized paraspinous tissues anteriorly are unremarkable.
    Impression:
    1. No evidence of significant spinal canal or foraminal stenosis. Mild multilevel degenerative disc disease in the mid and lower thoracic spine.
    2. No evidence of abnormal signal within the thoracic spinal cord.
    3. Old compression deformity of the superior endplate of T11 with mild wedging of the vertebrae. No significant loss of height.

    There are 5 lumbar-type vertebrae, and this convention is used for the purposes of this dictation. Scoliosis of the lumbar spine convex to the left. The tip of the conus medullaris is at approximately the level of L1. The lumbar vertebrae appear normally aligned. There is mild to moderate disc space narrowing and disc desiccation at L4/L5, L3/L4 and L5/S1.. Within the lumbar vertebral bodies, the bone marrow signal appears normal. The height of the vertebrae is normal.
    The findings on a level by level basis are as follows:

    L2-3: No focal abnormality is seen.

    L3-4: Mild broad-based bulge. Mild bilateral facet and ligamentum flavum hypertrophy. Mild bilateral neuroforamina narrowing. Central canal is normal..

    L4-5: Broad-based bulge asymmetric to the right. Significant bilateral facet and ligamentum flavum hypertrophy. Mild to moderate right neuroforamina narrowing. Mild left neuroforamina narrowing. Borderline central canal. Stenosis of the right lateral recess..

    L5-S1: . Based bulge asymmetric to the right. Mild right neuroforamina narrowing. Mild bilateral facet hypertrophy..

    The paraspinous tissues anteriorly are unremarkable.

    IMpression:

    Impression: Mild scoliosis of the lumbar spine convex to the left. Mild to moderate multilevel degenerative disc disease as described above. Findings are most significant at L4-L5.

    I also have bilateral carpal tunnel and bilateral Sensory Neuropathy of the lower extremities , as well as Bilateral cervical Radiculopathy. ANy help understanding this and what it may entail for my future would be a great help

     
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    Old 08-11-2013, 01:57 PM   #2
    WebDozer
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    Re: Please help me understand my mri

    Your radiologist is using standard adjective terminology, to wit:

    minimal = I can just make it out

    mild = clearly visible, but not of concern

    moderate - larger, and of borderline concern

    severe = this needs attention

    I"ll take one level and go over the terms...

    << C5-C6 >>

    The C5 and C6 vertebrae. The C6 nerve leaves the cord at this level and goes down to your thumbs.

    << Disk osteophyte complex is seen at this level >>

    The vertebrae are "growing" osteophytes (bone spurs) off the margins where they contact the C5-6 disk.

    << broad based Bulge is seen >>

    The disk itself is also bulging backward into the spinal canal.

    << There is flattening of the cord >>

    The disk and/or the osteophytes have pushed back into the canal far enough to reach the spinal cord, and have flattened the front side of its normally circular outside.

    << probable moderate central stenosis is seen >>

    That kind of goes without saying, if the cord is flattened. Stenosis = narrowing.

    << Midline AP diameter of thr thecal sac measures approximatly 6 mm >>

    The thecal sac is the membrane that surrounds the spinal canal and holds in the cerebrospinal fluid. To say the thecal sac measures 6mm is more or less like saying the spinal canal measures 6mm. The measurement is taken front-to-back (AP) in the middle of the canal. I have seen measurements down to 4mm, but 6mm is quite narrow, and should be viewed with concern.

    << Probable severe neural foraminal narrowing is seen on the left. Probable moderate to severe neural foraminal narrowing is seen on the right. >>

    The foramina are the holes in the front/sides of the spinal cage, through which pass the spinal nerves, after leaving the spinal cord and heading down into your arms. These openings have become obstructed, worse on the left side. If the spinal nerve is being pinched by the obstruction (radiculopathy), then you might have pain in your neck, and/or a variety of nerve-related symptoms going down into your shoulders and arms. A signature symptom of C6 nerve radiculopathy would be symptoms in the thumbs.

    << Probable mild to moderate hypertrophic changes are seen involving the unconvertabral joints. >>

    The uncovertebral "joints" are sort of like lipped edges of the vertebrae, forming "saddles" to help hold in the disks and stabilize the spine. Needless to say, these suffer stress from the time you're born, and over many decades are prone to building up bone overgrowth (hypertrophy). This overgrowth, along with the bulging disks and the disk osteophyte complexes, are probably combining to narrow your foramina.

    << Mild retrolethesis is seen. >>

    One of the two disks is displaced to the rear (retro) in relation to the other. I suppose he means the C5 is displaced backward over the C6, but I really don't know. Anyway, he says it's "mild".

    I would start with anything characterized as "severe" and work from there. I'd also consider that the 6mm measurement at C5-6 may be worse than of "probable" concern. Reading these images is an art, and the radiologist may have called it severe if he'd had another cup of coffee. Or another radiologist might have called it severe.

    I'd also really want to know about that edema. Edema WITHIN THE CORD would be of real concern. Yours is with the vertebral bodies, though, so I don't know if it is concern in and of itself, or merely might be indicative of a problem elsewhere. It may be due to long-term spinal compression. Anyway, I don't know, but I'd want to find out.

    I didn't see anything alarming in your lumbar. In the thoracic, the lower levels are not so good, but I don't know that they'd be causing symptoms, and I doubt that anything much could be done if they were.

    You did not mention symptoms, but I suppose they are extensive, if you were sent for three MRI's.

    Please keep in mind that I'm very much an amateur, even if I sometimes manage to sound well-informed...

    Last edited by WebDozer; 08-11-2013 at 02:03 PM.

     
    Old 08-12-2013, 11:05 PM   #3
    phianthus
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    Re: Please help me understand my mri

    Hi Webdozer,
    thanks for the response.

    I should have clarified the lumbar and thoracic MRI was done last year, and only this last week the MRI was done on my cervical neck, and i have since heard from the OD that she wants me to go see the neurosurgeon, as for the edema it does concern me, as i also have Thyroid Cancer that is recurrent, and last WBS didnt come back so great but thats another story.

    The back and neck promblems i have now is from a work related accident 9 years ago, emg also shows sensory neuropathy, in both upper and lower extremities, which has been ongoing for the last 8 years or so, lots of burning, ans sharp pain in neck, shoulders arms, and legs, constant parathesia, in legs arms hands and feet. I also ahve bilateral carpal tunnel i see the surgeon next week about..

     
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