68-year-old female with a history of lesions in T3, T6, T7 and T12 suspicious for myeloma. Bone marrow biopsy shows less than 10% plasma cells. Evaluation of the left hip and surrounding bone and soft tissue is limited by metallic susceptibility artifact related to the patient's left total hip arthroplasty device. There is mild generalized heterogeneity of the bone marrow of the pelvis which is nonspecific and may simply represent residual red marrow elements. There is a subcentimeter round lesion within the proximal right ischium which has intermediate signal intensity on T1 weighted images and high signal intensity on T2-weighted images and shows enhancement on postcontrast sequences which may represent a small myelomatous deposit. There is a focus of low signal intensity of about 1 cm within the posterior aspect of the right ilium that shows no enhancement and may represent a bone island. There is a 2 cm focus of high signal intensity on fat-saturated T2-weighted images within the L4 vertebral body that appears to enhance following contrast, however, it is intermediate to high signal intensity on T1-weighted images and may represent a hemangioma rather than a myelomatous deposit. There is also a tiny 4 mm round hyperintense lesion within the L5 vertebral body seen on image 16 of series 701 which may represent a myelomatous deposit. Moderate to severe degenerative disc disease affects the lower lumbar spine. There is a small juxtavaginal cyst to the left of midline which may represent a Bartholin's gland cyst. There is atrophy of the gluteus medius and minimus muscles, particularly on the left.
Small subcentimeter round lesions within the right ischium and L5 vertebral body are nonspecific but may represent myelomatous deposits. A larger lesion within the L4 vertebral body is not optimally imaged on this study, but may represent a hemangioma. Other findings as described above.