BACKGROUND: Magnetic resonance imaging (MRI) is highly sensitive and specific for detecting bone metastases. Patients with HIV have an increased risk of certain cancers, and MRI plays an important role in detecting metastatic disease. However, diagnostic accuracy may vary depending on the use of contrast medium and imaging sequences.

CASE REPORT: A 69-year-old woman with HIV presented with an insidious onset of lumbar radiculopathy. She underwent lumbar spine MRI without contrast, which revealed degenerative changes. Despite conservative management, she continued to have intractable pain and developed new upper extremityweakness. Repeat MRI 2 months later revealed innumerable metastases throughout herspine, ribs, and pelvic bones.

CONCLUSIONS: This case highlights a potential limitation of MRI in detecting metastatic lesions.

Pain physicians should individualize treatment according to the patient’s presentation, consider contrast-enhanced MRI and appropriate imaging sequences to optimize diagnostic accuracy, and repeat diagnostic testing when clinically indicated.

KEYWORDS: MRI; metastatic cancer; metastases; lung cancer; HIV; AIDS; non-AIDS; contrast; diffusion-weighted imaging