Fundamentals of Clinical MRI

Clinical case details: You are performing a lumbar spine MRI examination on a 55 year old
male on 26th February. The patient was examined on 21st February by the referring clinician.
The radiology referral form indicates the following:
• Discectomy four months ago at the L5/S1 level; now has severe pain despite having
improved post-surgery
• Restricted movement and pain in the leg and lower back at 50⁰ of hip flexion on SLR
• Surgical skin incision healed uneventfully; temperature 38.5⁰
• ?recurrent disc prolapse ?new pathology
Results of blood tests performed on 24th February include the following:
• ESR: 18 mm/hr
• CRP: 6 mg/L
On arrival, the patient indicates to you that the pain is on the same side and similar
location as pre-surgery, although he now notices numbness and pain on top of his right
Your routine lumbar spine (post-surgery) imaging protocol is as follows:
• Sagittal T2 and T1
• Axial T2 and T1 (planned from L3-S1)
• Post Gadolinium contrast scans (if required)
Use all of this information, supporting images and relevant literature, to answer the
questions below in essay format.
• Based on the above information, consider patient presentation and symptoms,
pathophysiology and risk factors to generate the most likely possible cause(s) for
patient presentation
• Describe typical imaging appearances of potential differential diagnoses
• Critically evaluate the contribution that each of your imaging sequences would make
to excluding or confirming each of the differential diagnoses
• Suggest any modifications or additions that you might wish to make to this imaging
protocol during the examination, including assessment of the use of gadolinium, and
justify why you would do this.

Sample Solution