77-year-old female with metastatic breast cancer and worsening hip pain. There is heterogeneous signal abnormality within the right ischium that corresponds to a treated metastasis seen on prior PET/CT and CT examinations dating back to 2011. The lesion is of heterogeneously high signal intensity on T2-weighted imaging and is predominantly fat signal intensity on T1-weighted imaging with relatively small areas of nonadipose signal on T1-weighted imaging. There is mild enhancement of the lesion following administration of gadolinium. The cortex surrounding the lesion is intact, representing healing when compared to the prior study from 2011. There is very mild poorly-defined edema-type signal abnormality within the head, neck, and intertrochanteric region of the right femur seen on T2-weighted imaging that shows minimal enhancement on postcontrast images. On the T1-weighted images, however, the marrow signal intensity of the femur is of fat signal intensity, more so than that on the contralateral side, suggesting that this is a site of a prior radiation port; therefore, these likely represent postradiation changes.. There is a trace amount of fluid within the right hip joint. There is mild synovial enhancement suggesting a very mild synovitis, but we see no erosions. The remainder of the visualized bone marrow is within normal limits. Degenerative disc disease affects the lower lumbar spine. We see no tendon tearing or gross asymmetry of the musculature of the pelvis. There are small right-sided obturator lymph nodes. Mild degenerative arthritis affects the pubic symphysis. Lobulated fat within the buttocks likely represents injection granulomas.
1. Findings compatible with the patient's history of a treated ischial metastasis. We see no additional lesions to suggest metastatic disease to bone.2. Minimal right hip synovitis which may reflect prior radiation therapy.3. Degenerative disc disease of the lower lumbar spine and other findings as described above.