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Case Challenge: Spine MRI Cases


Spine MRI Case Challenge Pre-Course Activities
2 topics

3b - Answer: Back pain, arthritis, osteomyelitis, and anemia in a patient with sickle cell disease

David Yousem MBA, MD
David M Yousem, MBA, MD
Professor of Radiology, Vice Chairman and Associate Dean
Includes DICOM files

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Case Report

HISTORY: Septic arthritis/osteomyelitis/anemia in patient with sickle cell disease, back pain

TECHNIQUE:

MR images of the lumbar spine were performed before and after administration of gadolinium at a dose of 0.1 mmol per kilogram.

FINDINGS:

The alignment of the vertebral bodies is normal. The conus medullaris terminates at an appropriate level. There is no evidence of pathologic enhancement in the discs or the endplates associated with the disc to suggest discitis or osteomyelitis.

However there is high signal intensity in multiple vertebral bodies associated with enhancement of the vertebral bodies anteriorly seen at S2, L5, L4, L3, L1, and T12. Additional areas of enhancement are seen in L2 affecting the right pedicle and posterior vertebral body. The right pedicle of L4 also shows high signal extending into the facet joint, new since September 3, 2021. The L1 right-sided pedicle also is newly bright.

Axial scans through the lumbar spine show no evidence of paraspinal mass or abnormal signal in the psoas musculature.

There is abnormal signal also seen in the sacroiliac region bilaterally without enhancement of the joint identified..

When compared to the prior MR of September 3, 2021 the anterior vertebral body changes at T12, L1, L3, L4, L5 are new.

IMPRESSIONS:

  1. Interval multiple areas of bone marrow signal intensity abnormality at T12 to L5 anteriorly worrisome for bone infarction and edema. Multifocal osteomyelitis is less likely.
  2. No evidence of discitis.

LESSON 2, TOPIC 9

Case Challenge: Spine MRI Cases

Case Challenge

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