 Corresponding to the area of abnormal signal predominantly in the L4 vertebral body posteriorly extending into the left pedicle, there is prominent stippled enhancement. More ill-defined enhancement also involves the superior endplate of L5 on the left, also extending into the left pedicle. There is severe disk space narrowing at this level with enhancement within the posterior disk space on the left side, as well as along the left facet. No definite associated paravertebral or epidural soft tissue mass is identified. Concurrent left hip MRI images demonstrate mild ill-defined T2 hyperintensity and enhancement extending into the left paraspinal soft tissues. No other areas of abnormal enhancement are seen.Correlation with previous PET/CT demonstrates a prominent sclerotic area involving this portion of the L4 vertebral body with extra vertebral bone formation extending along the left anterolateral aspect. There is a small focal lucency along the very left lateral aspect of the posterior L4 vertebral body. Severe bilateral facet arthropathy is noted at L4-L5. There is also a prominent left lateral osteophyte at L5-S1. Review of the outside PET/CT images demonstrates and oval area of increased uptake along the left L5 level, although not beyond the confines of the vertebral body.There is redemonstration of a large nonenhancing partially visualized cyst off the lower pole the left kidney. There are additional partially exophytic lesions of both kidneys, some of which demonstrate intrinsic T1 hyperintensity suggestive of blood products, especially as there is some layering.
Corresponding enhancement involving the left posterior L4 vertebral body and to a lesser degree the left L5 superior endplate extending into the left pedicles, in areas of previously noted abnormal signal. Given severe degenerative changes and lack of epidural/paravertebral soft tissue, findings are more favored to represent severe degenerative changes with adjacent reactive changes rather than metastatic disease or infection. However, outside PET/CT demonstrates a small area of corresponding increased uptake along the left L5 vertebral body in addition to corresponding significant sclerosis and osteophyte formation. Biopsy is recommended for further evaluation, to exclude metastatic involvement. Bone scan could also be considered to evaluate for other osseous metastatic disease.