Clinical question: Assess for radiolucent lesion in L3 vertebrae. Sclerotic lesion in the lumbar spine. Signs and symptoms: Assess radiolucent lesion in the L3 vertebrae. Pre and post enhanced lumbar MRI:Examination demonstrates a well-demarcated focus of T1 and T2 hyperintense vertebral body of L3 which saturates on sagittal fat sat series without enhancement and is consistent with a focus of fatty deposit.The signal intensity of the vertebral column otherwise demonstrate changes consistent with degenerative disc disease and unremarkable otherwise.There is no abnormal enhancement of the vertebral column, the most visualized thoracic cord, conus or the cauda equina. There is however expected mild enhancement of hypertrophic changes of the ligamentum flavum in the lower lumbar spineT11-T12 and T12-L1 levels demonstrate mild degenerative changes and unremarkable otherwise.L1-L2 demonstrate moderate disc disease and loss of disc height and mild facet and ligamentum flavum hypertrophy without spinal stenosis or neural foraminal compromise.L2-L3 demonstrate moderate disc disease and loss of disc height, moderate bilateral facet and ligamentum flavum hypertrophy and including mild bilateral facet effusion. Constellation of findings results in mild central spinal stenosis and moderate bilateral neural foraminal compromise.L3-L4 demonstrate moderate disc disease and loss of disc height, moderate bilateral (R>L) ligamentum flavum and facet hypertrophic changes which also includes right facet effusion. Constellation of changes results in significant central spinal stenosis, significant right and moderate left neural foraminal compromiseL4-L5 demonstrate moderate disc disease and loss of disc height, extensive bilateral (R>L) facet and ligamentum flavum hypertrophy. Constellation of changes results in grade 1 anterolisthesis and significant central spinal stenosis with moderate left and significant right neural foraminal compromise.L5-S1 demonstrate advanced disc disease with significant loss of disc height, mild bilateral facet and ligamentum flavum hypertrophy and mild grade 1 anterolisthesis. There is no spinal stenosis or neural foraminal compromise.
1.Focus of marrow signal change in L3 vertebral body is consistent with a fatty deposit and there is no evidence of metastatic disease on this exam.2.Degenerative changes at L3-L4 with resultant moderate central spinal stenosis, extensive degenerative changes at L4-L5 level with significant central spinal stenosis. There are also associated neural foraminal compromise more significantly at L4-L5.3.Mild degenerative changes at other levels however without central spinal stenosis.4.Neural foraminal compromise at other levels as detailed per level above.