Clinical question: Workup for vertebral body masses. Signs and symptoms: Vertebral body masses thoracic and lumbar vertebrae. Nonenhanced lumbar MRI:Examination demonstrate diffuse marrow signal replacement involving vertebral bodies of L1 and L2. The signal changes are T1 hyperintense, T2 hyperintense and T2 stir hyperintense pattern suggestive of extensive fatty of the vertebral body. Axial images demonstrate course bony trabeculation. The findings are likely to represent either radiation or fatty deposit within the vertebral bodies or possibly hemangiomas. There is no evidence of fracture or malalignment at this level and no detectable epidural or paraspinal associated soft tissue abnormalities.Examination also demonstrate a large focus of marrow signal replacement involving extensively the vertebral body of L4. The signal changes consist of T1 hypointense and T2 iso to hyperintense and T2 stir hyperintensity. This vertebrae also demonstrate coarse trabeculation through the lesion and highly suggestive of a hemangioma as well. No fracture or malalignment. No evidence of perispinal or epidural associated soft tissue abnormality. Tiny additional foci of similar signal changes is noted in the superior aspect of body of T12 and the spinous process of L2 as well suggestive of hemangioma.The alignment the vertebral column is anatomical.T12 -- L1 is unremarkable.L1 -- L2 demonstrate advanced disk disease with significant loss of disk height and mild facet and ligamentum flavum hypertrophy. No spinal stenosis or neural foraminal compromise.L2 -- L3 demonstrate moderate disk disease and loss of disk height, mild facet and ligamentum flavum degenerative changes. No spinal stenosis or neural foraminal compromise.L3 -- L4 demonstrate mild disk disease and loss of disk height and mild facet and ligamentum flavum degenerative changes. No spinal stenosis or neural foraminal compromise.L4 -- L5 demonstrate moderate disk disease and loss of disk height, moderate left and mild right ligamentum flavum and facet hypertrophy. In addition there is a central and rightward broad based disk protrusion. Constellation of above findings results in moderate central spinal stenosis and moderate right neural foraminal compromise.At L5 -- S1 demonstrate moderate disk disease and loss of disk height, moderate left facet and bilateral ligamentum flavum hypertrophy and mild right facet disease. No spinal stenosis. Moderate to severe left neural foraminal compromise is however present.Normal signal intensity and morphology of conus and the cauda equina.There is no detectable perispinal soft tissue abnormalities. Psoas muscles are symmetrical and appear normal in size and morphology for stated age of 79. Bilateral kidneys are unremarkable.
1.Multiple foci of marrow signal replacement involving the vertebral bodies and posterior elements which are all suggestive of hemangioma as detailed above. There is no evidence of fracture or malalignment or any associated soft tissue abnormality with the above findings.2.Degenerative changes at L4 -- L5 and including a central and right-sided disk protrusion results in moderate central spinal stenosis and right neural foraminal compromise.3.Degenerative changes at other levels of varying degrees however without central spinal stenosis as detailed per level above.4.Asymmetric left-sided facet hypertrophic changes at L5 -- S1 results in moderate to severe left neural foraminal compromise.