Reason: Worsening lower back pain; evaluate for disease progression History: Stage IV melanoma There are multiple foci of abnormal signal intensity noted within the bones of the pelvis bilaterally, including the sacrum, as well as within the proximal femora. The lesions are of variable signal intensity on T1-weighted images with some being iso- to hypo-intense to skeletal muscle and others that appear hyper-intense to skeletal muscle, perhaps due to melanin. The majority of the lesions are increased in signal intensity on T2-weighted images, although some show low signal intensity centrally on the STIR sequence. Some, but at all, of the lesions appear to enhance following contrast administration. There is a lesion within the femoral neck, on the left, that abuts the superolateral cortex, but the cortex itself appears intact and we see no extraosseous spread of tumor at this location. Another lesion is situated in the right proximal femur at the level of the lesser trochanter, adjacent to the lateral cortex. There is an associated small amount of edema within the adjacent soft tissues, but there is no visible cortical destruction. There is a small amount of fluid within both hips, but no joint effusion is evident. There is mild edema noted within and along the musculature of the hips bilaterally, which is nonspecific. We see no fluid collection to indicate an abscess. Please refer to the lumbar spine MRI report for additional details regarding the lumbar spine.
Multiple metastatic foci involving the bones of the pelvis and proximal femora.