Incorporation of Whole Spine Screening in Magnetic Resonance Imaging Protocols for Low Back Pain: A Valuable Addition

STUDY DESIGN: A retrospective review of lumbar magnetic resonance imaging (MRI) studies conducted at the Department of Radiodiagnosis & Imaging of a Tertiary Care Armed Forces Hospital between May 2014 and May 2016. PURPOSE: To assess the advantages of incorporating sagittal screening of the whole spine in protocols for conventional lumbar spine MRI for patients presenting with low back pain. OVERVIEW OF LITERATURE: Advances in MRI have resulted in faster examinations, particularly for patients with low back pain. The additional detection of incidental abnormalities on MRI helps to improve patient outcomes by providing a swifter definitive diagnosis. Because low back pain is extremely common, any change to the diagnostic and treatment approach has a significant impact on health care resources. METHODS: We documented all additional incidental findings detected on sagittal screenings of the spine that were of clinical significance and would otherwise have been undiagnosed. RESULTS: A total of 1,837 patients who met our inclusion criteria underwent MRI of the lumbar spine. The mean age of the study population was 45.7 years; 66.8% were men and 33.2% women. Approximately 26.7% of the patients were diagnosed with incidental findings. These included determining the level of indeterminate vertebrae, incidental findings of space-occupying lesions of the cervicothoracic spine, myelomalacic changes, and compression fractures at cervicothoracic levels. CONCLUSIONS: We propose that T2-weighted sagittal screening of the whole spine be included as a routine sequence when imaging the lumbosacral spine for suspected degenerative pathology of the intervertebral discs.

Sign of Leser-Trelat: an association with benign swellings

Sign of Leser-Trelat [SLT] is defined by sudden eruption of numerous seborrheic keratosis or rapid increase in the number of pre-existing seborrheic keratosis. It has been reported as a paraneoplastic manifestation in literature but its position as a paraneoplastic manifestation has both strong opponents and proponents. We hereby, report a case of a 49-year-old male who presented to us with SLT-like lesions in association with benign swellings of neck and scrotum