Medical Imaging Analysis Report

I. Imaging Findings

Based on the provided lumbar-sacral MRI and CT images, the following observations are noted:

• A well-demarcated lesion within the sacral vertebrae (at S1–S2 level);
• On MRI T1-weighted images (T1WI), the overall signal is low to isointense, with some small high-signal areas (possibly indicating fatty components);
• On MRI T2-weighted images (T2WI), the lesion shows relatively high signal intensity without obvious soft tissue masses or bone destruction;
• On CT scans, the lesion appears as a mildly high-density area, without significant bony destruction or cortical expansion;
• The lesion has a fairly clear boundary, and no obvious destruction of the vertebral structure or space-occupying lesion within the spinal canal is observed.

II. Potential Diagnoses

Based on the imaging characteristics and case history, and given that this 48-year-old female patient currently has no known history of tumors or systemic disease, the possible diagnoses or differential diagnoses include:

1. Benign Notochordal Cell Tumor (BNCT):
   This type of lesion is often an incidental finding, typically showing low or isointense signal on T1WI and high signal on T2WI, without significant enhancement or soft tissue invasion. These features correspond to this case.
2. Chordoma:
   Although also originating from notochordal remnants, chordomas usually exhibit more evident bone destruction, soft tissue masses, and noticeable enhancement. In this case, the absence of a clear soft tissue component argues against chordoma.
3. Metastatic Tumor:
   Usually associated with a known cancer history or multifocal lesions, often accompanied by osteolytic changes or other destructive features.
4. Hemangioma:
   Typically presents a “striped” appearance or noticeable vascular flow voids on MRI. On CT, it often appears as a low-density or mixed-density lesion, more commonly found in the thoracic or lumbar vertebrae. These features do not fully match this case.

III. Final Diagnosis

Considering the patient’s age, clinical symptoms (chronic back pain), lack of previous cancer history, and the typical MRI and CT features, the lesion is more likely to be diagnosed as a Benign Notochordal Cell Tumor (BNCT). Current studies suggest such lesions are benign and often do not require surgical intervention. However, because some literature indicates a possible connection to chordoma, regular imaging follow-up is recommended to rule out any progression or malignant transformation.

IV. Treatment Plan and Rehabilitation

1. Treatment Strategy
• Conservative Management: For most BNCT patients without significant neurological compression or severe pain, a conservative approach may be chosen, including pain management (e.g., oral anti-inflammatory analgesics) and regular imaging follow-ups.
• Surgical Intervention: Biopsy or surgery should be considered only if there is rapid lesion growth, bone destruction, nerve compression, or strong imaging suspicion of malignant change.
2. Rehabilitation / Exercise Prescription
• Individualized Exercise Program: Based on the patient’s back pain severity and physical condition, it is recommended to start with low-intensity, supported exercises, such as regular walking on flat ground or using the elliptical machine for about 15 minutes, 3–5 times per week.
• FITT-VP Principle (Progressive Overload):
  Frequency: Start with 3 sessions per week, then gradually increase to 5 times per week when pain improves;
  Intensity: Mild sweating and a slightly elevated heart rate are acceptable. Avoid high-impact activities;
  Time: Depending on the patient’s tolerance, gradually extend each session from 15 to 30 minutes;
  Type: Focus on low-impact aerobic exercise, with moderate core stabilization training (e.g., planks);
  Progression: If tolerable, incrementally increase exercise volume or duration every 2–4 weeks.
• Precautions: Reduce exercise intensity and avoid weight-bearing or strenuous activities if back pain worsens. Seek medical advice promptly if new or worsening symptoms occur, especially neurological symptoms such as numbness or severe pain in the lower limbs.

Disclaimer

This report is based solely on the current imaging and clinical information and provides a reference analysis. It is not a substitute for an in-person evaluation or professional diagnosis by a physician. If you have further questions or if symptoms change, please seek medical attention and follow a specialist’s advice.