43-year-old man with history of paraplegia. Evaluate for osteomyelitis Again seen is heterogeneous signal intensity and enhancement within the subcutaneous fat posterior to the sacrum, favored to represent a combination of edema, scar tissue and heterotopic ossification. There is irregularity of the overlying skin, presumably reflecting ulceration. The signal intensity of the underlying sacrum appears normal and we see no findings to suggest osteomyelitis of the sacrum.Again seen is a deep ulcer along the left gluteal fold extending to the left ischium, which was present on the prior MRI as well as a CT scan from 2014. There is mild decreased signal intensity of the left ischial tuberosity on T1-weighted images, as well as mild increase in signal intensity on the fat suppressed T2-weighted images. This appearance is consistent with chronic osteomyelitis. Increased signal intensity within the ischial tuberosity on the fat suppressed T2-weighted sequence appears slightly more prominent on the current study when compared to the prior study, but it is uncertain whether this represents a slight increase in bone marrow edema, or if this simply represents differences between the two MRI scanners. We are not convinced that there has been any further bone destruction when compared to the March 2016 study. Heterogeneous signal intensity adjacent to the left ischium presumably represents edema, scar tissue and heterotopic ossification, similar to the prior study.An additional sinus tract is again seen extending from the right gluteal fold to the right ischium, but we see no signal abnormalities to suggest osteomyelitis in this region.Postsurgical changes of a right Girdlestone procedure are again seen. We see no abnormal signal intensity in the proximal right femur to suggest osteomyelitis.Again seen is deformity of the left proximal femur with adjacent heterotopic ossification, which appears unchanged from the prior MRI. Osteoarthritis of the left hip appears similar to prior. Heterogeneous signal intensity in the soft tissues surrounding the left hip likely represents scar tissue and additional heterotopic ossification, and appears similar to prior.There is ankylosis of the sacroiliac joints, particularly on the right. There is diffuse muscle atrophy. Again noted is mild edema and enhancement of the gluteal musculature, but we see no findings to suggest an abscess. Increased T2 signal intensity within the adductor musculature may represent atrophy or mild edema, and appears similar to prior. There is a Foley catheter within the bladder.
1. Pelvic soft tissue ulcers as describe above, with findings suggesting chronic osteomyelitis of the left ischium. Although the degree of edema within the ischium appears to have increased slightly when compared to the prior study, this may simply reflect differences between the two MRI scanners. We see no findings to confirm progression destruction of the ischium.2. Other findings as detailed above, appearing similar to the prior study.