39-year-old male with sacral tumor, decreased perianal sensation. Please see same day lumbar spine MRI for lumbar spine findings.BONE MARROW: There is a large, expansile, mildly enhancing T1 low, T2 high signal mass extending from the left sacral alla inferiorly to the S5 level. Fluid and gas collection is noted within the spinal canal at S2-S3, likely postoperative The mass measures approximately 6.3 x 3.6 x 5.8 cm (series 17, image 13; series 18, image 22). The tumor has mass effect on left S1, S2, and S3 nerve roots possibly explaining the patient's decreased perianal sensation. Surrounding edema and marrow signal is present. There is mild peripheral enhancement and periosteal enhancement of the sacrum (S2-S5).There are multiple additional lesions in bilateral innominate bones that demonstrate central T2 hyperintensity with peripheral T1 hypointense borders. The largest of these lesions is in the posterior wing of the left innominate measuring approximately 6.2 x 2.6 cm (series 16, image 14) and demonstrates mild enhancement.A large mixed cystic and solid, expansile lesion demonstrating mild enhancement is noted within the right femoral neck and extends 14 cm distally into the metadiaphysis. The lesion measures approximately 5.9 x 3.2 cm (series 13, image 28) at the femoral neck. The femoral head is well-seated in the acetabula with anatomic alignment. No acute fracture is evident. Partially imaged is a thin T1 hypointense, T2 hyperintense lesion in the mid right femoral diaphysis only seen on coronal views. An enhancing, mixed intensity lesion is noted within the intertrochanteric region 2.8 x 2.6 cm (series 13, image 32).SOFT TISSUES: Partially imaged postsurgical changes of S1-S3 laminectomy and partial tumor resection with low T1/T2 signal and blooming artifact along the presumed surgical tract reflecting metallic fragments. Paraspinal soft tissue edema is noted without focal fluid collection. The presacral soft tissues are preserved without extension of the tumor into the presacral area. An epidural drain with tip superficial to the mixed fluid/gas collection is noted, better seen on the lumbar spine MR performed on the same day. JOINTS: No significant femoral joint effusions are present.ADDITIONAL
1.Multiple masses within the sacrum, innominate bones, and bilateral femurs as described above. The tumor has mass effect on the left S1, S2, and S3 nerve roots possibly explaining the patient's decreased perianal sensation.2.Post surgical changes of the S1-S3 laminectomy and partial tumor resection as described above. Postoperative fluid and gas collection is noted within the spinal canal at S2-S3. 