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Radiology/MRI Lumbar Spine without Contrast

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Hello Michael,

I got a MRI for the first time and the results are below.

Findings:There is a normal alignment of the lumbar vertebral bodies with no fracture or subluxation. Conus is normal in position.

L1-2, L2-3: No Disc herniation, spinal canal stenosis or facet arthropathy. Foramina are patient

L3-4: Mild Facet arthropathy with small amount of left-sided effusion. No disk herniation, spinal stenosis or foraminal narrowing.

L4-5: 4 mm broad-based left paracentral disc protrusion tightening the left lateral recess which may affect the traversing nerve roots. There is also a 3 mm modularity along the nerve root fibers of the cauda equina within the thecal sac, to the right side of the midline. This is best seen on axial image 23 and sagittal image 8.

L5-S1: Mild disc narrowing and desiccation. 3 mm central disc protrusion with annular tear slightly displacing the S1 nerve roots without impingement. Mild bilateral foraminal narrowing are seen without nerve root impingement.

Impression:

1. Central Disc protusion and annular tear at L5-S1, slightly displacing the S1 nerve roots without obvious impingement.

2. Left paracentral disc protrusion at L4-5 tightening the left recess which may affect the traversing nerve roots.

3. 3 mm modular lesion along the course of the cauda equina nerve root to the right side of the midline at the level of L4. Contrast-enhanced MRI is recommended for better evaluation. Considerations would include vascular lesion such as angioma, schwannoma or less likely metastases.

Why I got the MRI:

I have had a chronic issue with lower back pain off and on over the last few years, with a recent episode a few weeks ago. (No accidents caused pain). This episode was the worse so far and started after bending over to tie my shoes. I was unable to move due to searing pain in lower back and tightness in quads. Had to take ambulance to hospital bc I wasn't able to move off the floor . Pain Med shots at emergency room didn't help but when they made me walk, which did seem to help. Sitting seems to aggravated it. Out of work for 2 weeks. Back Aches still but not nearly as bad as that day.

Otherwise, I am in great shape, aside from a b12 deficiency. 32 yrs 6ft1in and 180lbs, distance runner (5k and 10k mostly). Manage a running store.

My general doctor seems on the fence about the 2nd MRI w/contrast suggestion, as requested for 3mm lesion by tech. In end, general doctor did order 2nd MRI, to cover all our bases. Is a 3mm lesion somewhat normal? If not, should I request to see a specialist after 2nd MRI?

Thanks,
Erik

Answer
Erik,

I appreciate all the information.  As I understand your question is regarding a 3 mm lesion.

It is not normal. I would think it in all likelyhood represents a small schwannoma if it will enhance on the MRI with contrast. I would certainly advise you to do the second MRI.  What to do about it is a different story.  Your symptoms do not suggest that it is causing you symptoms but it is good to know that it is there for the future, and which particular nerve it is involving.

Hope this is somewhat helpful.

MK

Radiology

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Michael K.

Expertise

Almost any kind of questions regarding any types of radiology exams, procedures, meaning of radiology reports etc...

Experience

12 year experience in the field of radiology

Organizations
American Society of Neuroradiology, Senior Member Society of Pediatric Radiology, Active Member

Publications
Radiology Seminars in pediatric neurology American Journal of Roentgenology American Journal of Neuroradiology

Education/Credentials
Board Certified in Diagnostic Radiology Additional Certificate of Qualification in Neuroradiology

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