<prompt> Please answer with one of the option in the bracket. Write reasoning in between . Write answer in between .Q:A 65-year-old man is referred by his primary care provider to a neurologist for leg pain. He reports a 6-month history of progressive bilateral lower extremity pain that is worse in his left leg. The pain is 510 in severity at its worst and is described as a burning pain. He has noticed that the pain is acutely worse when he walks downhill. He has started riding his stationary bike more often as it relieves his pain. His past medical history is notable for hypertension, diabetes mellitus, and a prior myocardial infarction. He also sustained a distal radius fracture the previous year after falling on his outstretched hand. He takes aspirin, atorvastatin, metformin, glyburide, enalapril, and metoprolol. He has a 30-pack-year smoking history and drinks 2-3 glasses of wine with dinner every night. His temperature is 99F 37.2C, blood pressure is 14585 mmHg, pulse is 91min, and respirations are 18min. On exam, he is well-appearing and in no acute distress. A straight leg raise is negative. A valsalva maneuver does not worsen his pain. Which of the following is the most appropriate test to confirm this patients diagnosis?? A: Ankle-brachial index, B: Computerized tomography myelography, C: Electromyography, D: Magnetic resonance imaging, E: Radiography,  <response>: This is a patient with progressive bilateral lower extremity burning pain that is worse with walking downhill. The pain is relieved by stationary biking. He has a history of hypertension, diabetes, myocardial infarction, and distal radius fracture. On exam, he has a negative straight leg raise and valsalva does not worsen his pain. The key finding is that his pain is worse with walking downhill but improves with stationary biking. This suggests neurogenic claudication likely from lumbar spinal stenosis. MRI is the best test to evaluate for spinal stenosis.Ankle-brachial index would be useful to evaluate peripheral arterial disease but his symptoms are not consistent with vascular claudication which would improve with rest. EMG could evaluate radiculopathy but MRI is better for evaluating the central canal. CT myelography is invasive and also not first-line. X-ray would not visualize the spinal canal well.D: Magnetic resonance imaging 