Presentation
Back pain
Patient Data
With exception of occasional hemangiomas the largest of which is situated in S2 the marrow signal throughout the imaged lumbar spine and pelvis is uniformly hypointense. This reflects the patient's investigated myelofibrotic syndrome.
The conus is situated posteriorly to L1 and demonstrates normal morphology and signal. Vertebral body height and postero-body alignment is maintained within normal limits.
At L1-2 and L2-3 there is no focal disc protrusion or central canal stenosis
L3-4 there is a broad-based disc bulge which indents the ventral aspect of the thecal sac, the central canal and exit foramina are however adequate
L4-5 a shallow disc bulge is present. Moderate bilateral facet joint arthrosis. Central canal and exit foramina are adequate.
At L5-S1 there is mild loss of intervertebral disc height and signal associated with a broad-based disc osteophyte complex. Laterally the left L5 root is contacted by a large lateral osteophyte which may contribute to neural irritation.
Conclusion:
Diffuse marrow placement related to myelofibrosis as per previous bone marrow aspirates.
Note definite direct neural impingement.
L5-S1 osteophytes may contribute potentially to left L5 nerve root irritation.
Case Discussion
A reasonable rule is that normal bone marrow, even red marrow, should be of higher signal than muscle on T1 weighted images. In this case the marrow signal is profoundly depressed in keeping with the patient's known myelofibrosis.
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