79-year-old female with new onset leg weakness, rule out stress fracture, possible AVN Evaluation is limited due to patient motion artifact and inability to complete the scan. We see no findings to indicate avascular necrosis of the femoral head or stress fracture of the proximal femur. On the large field of view images there is replacement of the anterior aspect of the right iliac crest with low to intermediate T1- and high T2-signal intensity as well as mild edema in the adjacent musculature. This is nonspecific, although upon review of prior pelvis radiographs from January 22 there is a short linear lucency traversing the iliac crest which could conceivably represent a nondisplaced fracture. However, we cannot exclude the possibility of a metastasis or marrow infiltrating process like multiple myeloma on the basis of this MRI. Additionally, a couple of small (5-mm and 3-mm) rounded foci situated more posteriorly within the right ilium are nonspecific, but could represent metastatic deposits or myelomatous lesions. Heterogeneity of the remaining marrow of the axial skeleton and proximal femora we suspect is due to residual red marrow.Mild osteoarthritis affects the hip. Evaluation of the labrum is limited, but we suspect there is a least a partial thickness tear through the anterosuperior labrum. A small amount of fluid is present within both hip joints without frank effusion. Small Tarlov cysts are noted along the right S1 nerve roots. There is severe fatty atrophy of the lower paraspinal muscles and also fatty atrophy of the gluteus minimus musculature, left greater than right.
Replacement of the anterior aspect of the right iliac crest with abnormal signal intensity which could possibly represent edema from a nondisplaced fracture, but we cannot exclude metastatic disease or a myelomatous lesion, particularly given that there are a couple of nonspecific foci of signal abnormality present more posteriorly within the iliac wing. If further evaluation is clinically warranted, CT scan of the chest, abdomen and pelvis may be considered to evaluate for primary primary malignancy (e.g., lung, renal) and simultaneously for an occult fracture of the right ilium. Serum protein electrophoresis may be considered to evaluate for multiple myeloma.