• Altered marrow signal is seen within the sacrum, T12 and L2 vertebral bodies but fatty signal foci is still seen internally at all the aforementioned levels. At L2 in particular, the AP diameter of the vertebral body is increased with mild loss of the posterior convexity in keeping with vertebral body expansion. The overall imaging features are suggestive of Pagets disease and confirmation of the trabeculation pattern with CT is recommended.