84-year-old female with right buttock/ischium pain, history of breast cancer. There are numerous T1 hypointense, T2 hyperintense lesions demonstrating enhancement scattered throughout the proximal imaged left femur and right femoral neck. No joint effusion is present. There are additional lesions with similar imaging characteristics in bilateral ischium. There is a large right iliac wing lesion that is again noted, appearing similar to that seen on prior PET. Additional lesions are also noted within the sacrum and visualized lower lumbar vertebral bodies. The S2 vertebral body is near completely replaced by tumor. Many of the aforementioned lesions correspond with mildly sclerotic PET/CT. There is high T2, edema type signal within the right iliacus muscle.There is leftward curvature of the visualized lower lumbar spine. There is 13 mm of anterolisthesis of L5 on S1, grade 1/2 with uncovering of the intervertebral disc. There is severe neural foramen stenosis at L5-S1, right greater than left. A fat-containing umbilical hernia is present. A cystic lesion in the left hemipelvis is likely adnexal in origin and measures 1.4 x 1.1 cm.
1.Numerous enhancing lesions scattered throughout the osseous structures as described above consistent with diffuse metastases. 2.13 mm of anterolisthesis of L5 on S1, grade 1/2, with uncovering of the intervertebral disc. There is severe neural foramen stenosis at L5-S1, right greater than left. 3.Edema type signal within the right iliacus muscle may be reactive from reported radiation therapy.4.Cystic lesion in the left hemipelvis is likely adnexal in origin. Given its size greater than 1 cm, follow up in one year with ultrasound may be considered. A serous inclusion cyst is favored. 