55-year-old male. Patient with pain in left femur radiating to left buttock. Please evaluate for metastatic disease. History of metastatic melanoma. Pelvis: Numerous T1 hypointense and T2 hyperintense lesions in the pelvis (sacrum, bilateral ilia, right superior and inferior pubic rami, left ischium) and visualized lower lumbar spine consistent with metastases. Vertebral body and posterior element metastases are seen from L3 to L5 with posterior epidural extension of tumor at L4 causing partial effacement of the ventral thecal sac (series 6, image 3), which can be better evaluated with dedicated MRI lumbar spine imaging as clinically warranted. No pathologic fracture is identified.Left femur: Multiple T1 hypointense and T2 hyperintense medullary metastases are seen mostly from the intertrochanteric region to the mid diaphysis. An additional small metastasis is seen in the distal femur (series 10, image 19). No cortical breakthrough of these lesions or pathologic fracture is evident. Post-surgical findings of left knee ACL reconstruction. Similarly in the right femur as seen on the large FOV images, there are multiple metastases mostly in the proximal to mid diaphysis.
1. Multiple pelvic and bilateral femoral metastasis without evidence of a pathologic fracture.2. Lower lumbar spine metastases from L3 to L5 with posterior epidural extension of tumor at L4. This can be further evaluated with dedicated MRI lumbar spine imaging as clinically warranted.