Fig. 12.

a T1-weighted, b T2-weighted sagittal images of the lumbar spine demonstrate no marrow abnormality. There is only a subtle antero-posterior expansion of the L2 and L4. The diagnosis in these patients can be missed on initial MRI. c Lateral radiograph of the lumbar spine demonstrates the classic pagetic changes including vertebral expansion, trabecular hypertrophy and cortical thickening in L2 and L4. There is an incidental non-pagetic vertebral compression at L1. There is again preservation of the fat signal within the vertebrae involved in PD