case_images: PMC11440935_01
case_images: 68Ga-PSMA-11 PET/CT images with multiplanar reformats show ill-defined endplate sclerosis, irregularities, and small erosions around the L4-L5 intervertebral disc with increased focal radiotracer uptake at the L5 vertebral body.
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case_images: F1
case_images: I) and the left base (Gleason 7, grade II). 68Ga-PSMA-11 PET/CT revealed numerous radiotracer-positive lesions in both prostate lobes- the left prostate SUVmax was 10.7 and the right prostate SUVmax was 4.3- with associated sclerotic lesions on L4 and L5, but only L5 showed increased radiotracer avid with an SUVmax of 6.5 raising the possibility of metastasis (Figure 1). In light of these findings, an MRI was recommended to determine the nature and extent of the lesion in the vertebral body.
case_images: MRI of the lumbar spine shows advanced degenerative disc changes at L4-L5 level with endplate irregularities and small schmorl's nodes seen on (A) T1 and (B) T2 weighted-images as well as bone marrow signal abnormality at L5 vertebral body best appreciated on (C) STIR images.
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case_images: F2
case_images: The MRI of the lumbar spine did not show any signs of bony metastasis but raised the possibility of an aggressive MODIC type 1 lesion vs. an infectious/inflammatory process (Figure 2).
case_images: CT-guided percutaneous core biopsy of the sclerotic and radiotracer-avid area at the L5 vertebral body through a transpedicular approach.
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case_images: F3
case_images: A CT-guided biopsy was performed on the bone lesion at L5 of the radiotracer avid area, and no evidence of metastasis, infection, or inflammation was found on histology (Figures 3, 4).
case_images: Fragments of bone and bone marrow. No inflammatory cells. Negative for malignancy.
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case_images: F4
case_images: A CT-guided biopsy was performed on the bone lesion at L5 of the radiotracer avid area, and no evidence of metastasis, infection, or inflammation was found on histology (Figures 3, 4).