Extraspinal Critical Findings on Lumbar Spine Imaging: What the Neuroradiologist Cannot Afford to Miss

Increased use of CT and MR imaging of the spine has led to a proportionate increase in incidental findings. Lumbar CT and MR imaging in particular are ordered for a number of reasons, including low back pain, radiculopathy, excluding cord compression, spinal stenosis, and so forth. It is routine practice to reduce the FOV of images to better characterize the spine. However, areas peripheral to the region of interest are still seen. Consequently, extraspinal findings with varying degrees of clinical relevance may be present and may be the etiology for the referred pain and responsible for the misdiagnosis of spinal and/or neurologic etiologies. The goal of this article is to introduce a number of crucial extraspinal findings on lumbar spine imaging to guide neuroradiologists to differentiate clinically significant abnormalities that require further attention, secondary communication, and possibly intervention. Key points will be enumerated with the cases. The cases will include retroperitoneal, vascular, gastrointestinal, hepatic, and pelvic pathologies.

Learning Objective: To assess the extraspinal compartments on lumber spine imaging and identify any critical or urgent findings that would require more prompt diagnosis and management.