Clinical question: Evaluate for bone lesion. Signs and symptoms: 71-year-old female with left hip and thigh pain, remote history of breast cancer. Nonenhanced lumbar MRI:There is no convincing evidence of an osseous metastatic lesion on this nonenhanced study.There is normal anatomical alignment of vertebral, and without evidence of fracture.There is no detectable paraspinal or epidural abnormality on this non infused exam.Examination of T10-T11 and T11-T12 is unremarkable.T12-L1 demonstrate a right lateral disc protrusion (sagittal T2 series 1101 image 10, axial T2 series 1001 image 37). Finding results in subtle mass effect on the thecal sac however without spinal stenosis or neural foraminal compromise. The signal intensity of the cord is within normal.L1-L2 is unremarkable.L2-L3 demonstrate mild disc desiccation and loss of disc height, mild bilateral ligamentum flavum hypertrophy and mild facet disease. There is a well-demarcated epidural lesion in the left paramedian location posterior to the vertebral body of L3 and extending inferiorly to the level of the left L3-L4 neural foramina. There is mass effect on the thecal sac and at the exiting left neural foraminal at L3-L4 level. This finding is not associated with any marrow signal intensity of adjacent bony structures and is highly suspected of an extruded/migrated disc fragment likely originating from and 2-L3 disc level. Without intravenous contrast remote possibility of a dural based metastases cannot be entirely excluded.L3-L4 demonstrate mild disc desiccation and loss of disc height and mild bilateral ligamentum flavum hypertrophy. There is no spinal stenosis and patent bilateral neural foramina.L4-L5 demonstrate advanced disc disease and loss of disc height, mild bilateral ligamentum flavum hypertrophy and moderate left, mild right facet hypertrophy changes. No evidence of a spinal stenosis. Moderate left and mild right neural foraminal compromise.L5-S1 demonstrate advanced disc disease and significant loss of disc height, mild bilateral facet and ligamentum flavum hypertrophy. No central spinal stenosis. Mild to moderate right neural foraminal compromise.
1.There is no convincing evidence of a metastatic lesion on this nonenhanced exam.2.A right lateral disc protrusion at T12-L1 with mass effect on the right exiting nerve root without spinal stenosis or neural foraminal compromise.3.Epidural well-demarcated lesion posterior to the body of L3 extending from L2-L3 disc level inferiorly to the left neural foramina at L3-L4 level highly suspected of an inferiorly migrated disc fragment. Without intravenous contrast less likely possibility of a dural based metastatic lesion cannot be entirely excluded. This finding results in mass effect on the left exiting nerve at the L3-L4 level. No associated marrow signal changes of adjacent bony structures.4.Degenerative changes at other levels as detailed and without spinal stenosis at any level.