How do you now for certain that the high T1 signal material below the conus is fat?
It attenuates on fat saturated sequences.
Are you likely to be symptomatic if you have a fatty filum?
Most cases are incidentally found, asymptomatic and of no clinical concern. In some patients however it may be associated with signs and symptoms of tethered cord syndrome. In such cases it is usually associated with a thickened filum and a low lying conus.
The lumbar canal and conus appear normal, with the tip of the conus located at the L1 level. Immediately below the conus, in the midline is a longitudinal streak of high T1 and high T2 signal tissue with attenuates following fat saturation and demonstrates no enhancement.