This patient was referred for an MRI even without a previous lumbar spine radiograph, and the present study demonstrates what most likely represents bone metastatic disease to the spine. 

When appearing as multiple and with an aleatory distribution, such as in this case, the diagnosis is easily made, as there are no differentials. However, sometimes a metastasis can appear as a single lesion involving one vertebral body, and special attention must be given to the MRI signal to not confuse it with a vertebral hemangioma, for example. 

Further investigation looking for the primary tumor was advised for this case. 

The most common primary neoplasms to be considered in this male patient are: 

• lung cancer
• prostate cancer
• renal cell carcinoma
• gastrointestinal tract malignancies
• melanoma