FIG 3. L2 metastasis with no response to therapy in a 37-year-old female patient with hepatocellular carcinoma.

A, T1-weighted MR image (583/12) obtained before radiation therapy shows hypointense change (arrow).

B, T2-weighted MR image (3800/128) obtained before radiation therapy shows high signal intensity (arrows).

C, Diffusion-weighted MR image obtained before radiation therapy shows hyperintense metastatic tumor (arrow).

D, Diffusion-weighted MR image obtained after radiation therapy shows hyperintense metastatic tumor (arrow). This patient experienced persistent back pain and had no decreased uptake shown on a bone scan obtained 6 months after therapy. With metastasis to the spine without clinical improvement, persistent hyperintense bone marrow on follow-up diffusion-weighted MR images obtained after therapy is noted.