Male, 73 years old, with low back pain in the setting of lung adenocarcinoma. Numerous patchy areas of T1 hypointense and STIR hyperintense marrow replacement are seen involving most of the visualized vertebral bodies with the possible exception of L1. The sacrum and iliac bones are also involved. Vertebral body heights are preserved. Within the limitations of a noncontrast examination, no evidence of significant epidural involvement is seen. Spinal alignment is anatomic.The distal spinal cord, conus and nerve roots of the cauda equina are unremarkable except as discussed below. No specific epidural abnormalities are identified.L1-2: Mild facet hypertrophy and ligamentum flavum thickening. Minimal disc bulging. No significant spinal canal stenosis. Mild bilateral foraminal narrowing. L2-3: Facet hypertrophy and ligamentum flavum thickening. Disc bulging. Mild spinal canal stenosis. Mild bilateral foraminal narrowing. L3-4: Facet hypertrophy and ligamentum flavum thickening. Disc bulging with a superimposed central superiorly directed extrusion. Severe spinal canal narrowing with effacement of CSF and crowding of the cauda equina. Moderate left and mild right foraminal narrowing. L4-5: Facet hypertrophy and ligamentum flavum thickening. Mild disc bulging. No significant spinal canal stenosis. Moderate bilateral foraminal narrowing.L5-S1: Facet hypertrophy and ligamentum flavum thickening. Mild disc bulging. No spinal canal stenosis. Moderate to severe right and moderate left foraminal narrowing.
Numerous areas of marrow replacement are seen involving the lumbar spine, sacrum and iliac bones which are highly suspicious for metastatic foci. No compression deformities are noted. Within the limitations of a noncontrast examination, no evidence of significant epidural disease involvement is seen.Multilevel degenerative findings are also demonstrated, most significantly affecting the L3-4 level where there is a severe generalized spinal canal stenosis. Scattered variable foraminal narrowing is also present, most significantly affecting the right L5-S1 foramen.