Figure 6d. Renal cell carcinoma in a 7-year-old boy. (a, b) Fast SE STIR whole-body MR images obtained at initial staging demonstrate a left renal mass and retroperitoneal lymph node metastases. A subtle hyperintense marrow lesion is seen in the L2 vertebral body (arrow in b). (c, d) Corresponding reformatted coronal (c) and axial (d) contrast-enhanced CT images show the renal tumor with retroperitoneal metastases and a small lytic lesion involving the L2 vertebral body (arrow in d). (e) Posterior view from bone scintigraphy does not reveal the vertebral lesion. (f, g) Follow-up fast SE STIR whole-body MR images, obtained after left nephrectomy and chemotherapy, demonstrate disease progression with new liver metastases (arrowheads in g) and help confirm the previously suggested bone metastasis. The L2 and L3 vertebral bodies show pathologic fractures and increased marrow signal intensity (arrows in f). (h) Only at follow-up did the bone scintigraphic findings become abnormal, with a posterior view showing increased tracer uptake at L2 (arrow).