Female, 65 years old, with low back pain, left radicular pain, and weight loss. Evaluate for soft tissue mass at L3. A 4 x 3 x 3 cm enhancing mass is evident centered along the left aspect of the L3 vertebral body. A large portion of the mass is extra osseous and abuts or invades the adjacent psoas muscle. However there is substantial nondestructive osseous involvement as well including the posterior lateral vertebral body, pedicle, transverse process and facet complex. The left L2-3 and L3-4 neural foramina may be infiltrated to a mild degree. However, no significant intracanalicular epidural involvement is seen. There is no loss of vertebral body height.Marrow signal characteristics are generally heterogeneous with endplate degenerative changes and edema at L2-3. However, no additional enhancing lesions are seen. Vertebral body heights are preserved. Trace retrolisthesis of L2 relative to L3, and L3 relative to L4 is noted.The visualized distal spinal cord and conus are within normal limits. No convincing spinal cord or leptomeningeal enhancement is seen.L1-2: Mild facet arthropathy. Ligamentum flavum thickening. No spinal canal or foraminal stenosis. L2-3: Facet arthropathy. Ligamentum flavum thickening. Mild disc bulging. No spinal canal stenosis. Moderate left foraminal narrowing. L3-4: Facet arthropathy. Ligamentum flavum thickening. Minimal spinal canal narrowing. Severe left and moderate right foraminal narrowing.L4-5: Facet arthropathy. Ligamentum flavum thickening. Minimal disc bulging. No spinal canal stenosis. Severe right and moderate left foraminal narrowing. L5-S1: Facet arthropathy. Minimal disc bulging. Mild foraminal narrowing.
An enhancing mass is evident centered along the left aspect of the L3 vertebral body. There is an extraosseous component abutting or infiltrating the psoas muscle, as well as nondestructive osseous involvement of portions of the vertebral body as detailed above. This lesion would be compatible with metastatic disease.No definite additional metastases are seen. Multilevel disc and posterior element degeneration is noted. While there is no high-grade spinal canal stenosis, severe foraminal narrowing is evident on the left at L3-4 and on the right at L4-5.