The abnormality is demonstrated within L1 vertebral body favouring the right hand side with disease extending to involve the anterior right pedicle measuring up to 3 cm in AP dimension
There is destruction including at the right vertebral body, medial and lateral pedicle and posterior vertebral body cortices. There is a central area of non-enhancing necrosis with peripheral solid post contrast enhancement that includes soft tissue thickening causing a draped curtain sign at the ventral central canal. -mass encroaches the anterior epidural space, tightly bound by the pll centrally, and more loosely bound laterally-draped curtain sign with apex in the middle
This causes severe central canal stenosis with reduction in AP canal dimensions down to 8 mm with near complete effacement of CSF signal from surrounding cauda equina nerve roots. The conus medullaris is approximately 15 mm proximal to this at the mid T12 vertebral body level. Extraosseous component which not only extends into the ventral epidural space but into right psoas. There is surrounding oedema-like signal change within the entirety of the rest of the vertebral body but not necessarily the spinous process or left pedicle and transverse process.
Impression: Destructive lytic lesion right side L1 vertebral body with extraosseous disease causing severe central canal stenosis. Differential would include atypical infection such as TB or primary malignancy. CT GA biopsy via a right pedicular approach with samples for histology and microbiology should be undertaken.
-penumbra sign on t1
-The involvement of posterior elements is more common in tubercular infections than in pyogenic infections. Posterior lesions enter into differential diagnosis with neoplastic lesions, particularly when there is relative preservation of disc space. Tubercular infections classically spread to adjacent ligaments and soft tissue in an antero-lateral direction (Fig. 12). The paravertebral abscesses are surrounded by a rim characterized by a robust and irregular enhancement, which can be seen in MRI. These abscesses tend to be larger in tubercular infections than in pyogenic infections