Clinical question: Rule out metastases. Signs and symptoms: Back pain. Pre-and post-enhanced lumbar MRI:Examination double straight a focus of marrow signal abnormality in the anterior/inferior aspect of L5 vertebrae which demonstrates uniform enhancement. This finding measures approximately at 8.8 times 9-mm on sagittal post enhanced series. The finding about the inferior and anterior bony cortex of vertebrae and without detectable destructive changes. There is no associated extra osseous enhancement with this finding which is suspected of a small metastatic lesion. Finding correspond to the previously suspected focus of hypermetabolic lesion on PET scan.There is no detectable additional foci of marrow signal abnormality or enhancement of vertebral column. There is also normal signal intensity and caliber of the lower most visualized thoracic cord, conus and cauda equina without detectable abnormal enhancement.Mild degenerative disk disease and mild to moderate hypertrophic changes of facets and ligamentum flavum is noted. There is however no evidence of spinal canal or neural foraminal compromise/stenosis at any level. There is a prominent Schmorl's node along the superior endplate of L5.Partially visualized SI joints are unremarkable.There is no detectable perispinal soft tissue abnormality or enhancement.
1.L5 vertebral body demonstrate an approximately 9 x 9 focus of marrow signal change with enhancement corresponding to region of hypermetabolic focus on prior PET scan and suspected of a metastatic lesion. No evidence of any additional foci of acute column enhancement. No detectable abnormal leptomeningeal enhancement.2.Mild degenerative changes of lumber spine without spinal canal or neural foraminal compromise at any level.