A lession i learned....

Today came across a very strange MRI. Well i can not say that first in my career but i was almost taken aback by the finding. There was a patent operated for L4-L5 disc herniation about 5 years ago. Since a month she started having leg pain. When i took the xray , the xray was showing disc degeneration at L4-5. Patient was operated with Laminectomy before 5 years. Now, i was suspecting a foraminal stenosis as clinically the picture was L4 and L5 root radiculopathy. But when i took MRI, there was a massive disc at L3-4 on saggital view in both T1 and T2 images. But, when i looked at the axial cuts, i could not identify the disc. When i spoke with my radiologist , he said that because there is complete block , and the print is not as good as the Monitor contrast, i was not able to see it on print images.
So , in other words, there was a massive central and right paracentral disc herniation, to an extent that has completely drained CSF out at that level and there was significant root crowding. A potential patient to develop cauda equina syndrome. i shall put the images soon.

Importance of High resolution MRI in Spine

So far fortunately i have worked in a set up where i have best of the best facilities. Two days back i had a patient who underwent an MRI for Lumbar spine with 0.2 T MRI. At first glance it appeared as if it is just a L5-S1 sequestered disc. But on close examination i could see that the fragment starts from upper border of L5 pedicle. Now, on saggital view i could not see the fragment to the best of its resolution. When i examined the axial cuts more closely i certainly could find that the fragment as such starts from lower border of L4-L5 disc space and down migrates upto L5-S1 disc's upper border. So all in all i want to state that for Spine MRI i would say the requirement should be atleast 0.5 T if you don;t have facility of 1.5T which is the best.