48 y/o man with a history of previous back surgery, now presenting with recurrent right leg pain.
T2-weighted saggital image (FSE)
T2-weighted axial image (FSE)
T1-weighted axial image
T1-weighted axial image with fat
sat, post Gad
A soft tissue mass effect is seen in the lateral recess on the right at L4-5,
replacing the normal epidural fat. After Gadolinium administration, marked
enhancement is seen in the lateral recess.
The differential diagnosis in a post surgical back includes primarily recurrent herniated disk vs. scar. Post surgical scar will usually show enhancement with Gadolinium, unlike recurrent disk. The fat suppression improves the conspicuity of the enhancement.