Figure 4: Lumbar spine MRI without and with contrast obtained 6 months after the initial presentation. (a) Sagittal T2 weighted and T1 weighted images without contrast and (c) sagittal postcontrast T1-weighted fat suppressed image. These images show marrow signal alteration with associated band-like areas of enhancement surrounding areas of nonenhancement with associated T1 and T2 hypointensity, consistent with diffuse osteonecrosis.