Further characterization of L3 lesion, incidentally found on MRCP. There is a prominently T2-hyperintense, T1-hypointense, noncontrast enhancing lesion involving the posterior central part of the L2 vertebral body that measures up to 2 cm. This correlates with faint sclerosis on the previous abdominal CT scan. The lesion abuts the inferior endplate, where there is a small intrabody herniation of the disc. The lesion is relatively well circumscribed from the adjacent normal-appearing marrow and shows an incomplete T1 hyperintense rim. A smaller similar lesion is present in L1 vertebral body, also adjacent to an intrabody herniation. Otherwise, the marrow is notable for minimal to degenerative type I signal subjacent to the endplates at T11-T12 and L2-L3 anteriorly. Alignment is notable for sagittal straightening. The vertebral bodies are preserved in height and there is no osseous expansion or destruction. There is disc desiccation and moderate height loss at L3-L4 disc and desiccation without height loss at L4-L5 disc. The spinal canal is fairly preserved with only mild narrowing as described below. The conus medullaris tip is at the lower L1 level which is normal. The conus medullaris has normal shape and signal characteristics.T12-L1 and L1-L2: There is no spinal canal or neuroforaminal stenosis.L2-L3: There is a small (6 mm) left central disc extrusion with caudal migration, which effaces the left lateral recess and may be impinging on the left L3 nerve root. Otherwise, there is no significant spinal canal or neural foraminal stenosis.L3-L4: There is a disc bulge that is eccentric to the right resulting in mild narrowing of the right subarticular recess (posteriorly displacing the traversing right L4 nerve root) and barely touches the exiting right L3 nerve root. There is also right more than left mild facet arthropathy and ligamenta flava thickening. Otherwise, there is no significant central spinal canal or neural foraminal stenosis.L4-L5: A disc bulge is eccentric to the left and mildly narrows the left subarticular recess and the left neural foramen. The disc also abuts the left L4 nerve root extra foraminally, where there is also annular fissuring. There is moderate bilateral facet arthropathy and mild ligamenta flava thickening. Otherwise, there is no significant central spinal canal or right neural foraminal stenosis.L5-S1: There is no significant foraminal or spinal canal stenosis.
1.The T2-hyperintense, relatively well circumscribed lesions in L2 and L1 vertebral bodies without osseous expansion or destruction are nonspecific but may represent atypical hemangiomas. Given the lack of contrast enhancement or known primary cancer, neoplasm is a less likely consideration. However, an initial short-term (1-2 month) follow-up by MRI is suggested or comparison with prior studies if available.2.Relatively mild multilevel degenerative disease as described above.