Figure 3.

Single photon emission CT (SPECT)-CT performed to characterise the nature of lesion in L1 found on MRI (right). The patient was experiencing right-sided low back and leg pain within the lateral thigh consistent with L4 sensory radiculopathy. On MRI, a low T₁ and T₂ signal focus within the body of L1 was identified, which was thought to be benign, e.g. a bone island; however, MR could not completely exclude metastatic disease. There was also evidence of osteophytes and Modic changes noted. On SPECT, however, no abnormality is noted within L1 to suggest underlying metastatic pathology. On the planar images, there is focal increased tracer uptake seen, involving the left lateral aspect of L3/L4 vertebra with further patchy increased tracer uptake seen involving the lumber spine, shoulders, right elbow, left knee and both feet. The focally intense area at L3/L4 corresponds to osteophytic changes at this level in keeping with degenerative changes.