Metastatic renal cell carcinoma with growing destructive lesion at L1. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. There is anenhancing T1 hypointense 2.5 x 1.4 cm mass centered within the left L1-L2 neural foramen and compressing the left L1 nerve root. There is caudal epidural extension. There is loss of the adjacent L1 vertebral body cortex. There are few foci of T1 and T2 hyperintensity within the lumbar vertebral bodies, probably hemangiomas. The conus medullaris is normal in position.The sacrum and bilateral iliac bones are heterogeneous on T1, with suppression on fat saturation, probably fatty infiltration. There is disc desiccation at L5-S1 with a disc bulge and right para median-central annular fissure. The disc bulge minimally abuts the left L5 nerve root. Paraspinous soft tissues are within normal limits.
Enhancing mass centered within the left L1-2 foramen, with disruption of the vertebral body cortex and extension into the epidural space, probable renal metastasis.