Female 69 years old Reason: myeloma with worsening sciatic pain left buttock Multiple sequences are limited by motion. BONE MARROW: Diffusely heterogeneous bone marrow signal on T1 and T2 imaging consistent with patient's known history of myeloma. Again seen is a focal T1 hypointense lesion replacing much of the L5 vertebral body, probably on the right. There is a soft tissue component to this lesion, similar to the recent lumbar MRI, which extends into the right retroperitoneum has mass effect on the vessels.SOFT TISSUES: Again seen is a T1 and T2 hypointense lesion in the far lateral left L5-S1 foramen which has mass effect on and appears to impinge the exiting L5 nerve root (series 5, image 8). Remaining sacral nerves are well-visualized and appear to be surrounded by fat. Large fluid collection adjacent to the left greater trochanter most likely represents bursitis. The left gluteal muscles are atrophied compared to the contralateral side.JOINTS: There is a large subchondral cyst at the lateral femoral head neck junction. ADDITIONAL
1.Diffuse abnormal bone marrow signal consistent with known myeloma.2.Large fluid collection adjacent to the left greater trochanter likely represents bursitis. Atrophy of the left gluteal muscles compared to the contralateral side.3.Lesion causing destruction of the L5 vertebral body is not significantly changed compared to most recent lumbar spine MRI.4.Impingement of the exiting L5 nerve root caused by a soft tissue abnormality in the lateral left foramen.