50-year-old female with multiple myeloma and new onset pain. Please evaluate for new myelomatous lesions. There is diffuse signal abnormality of the bone marrow of the pelvis and the proximal left femur on the T1-weighted images. Evaluation of the proximal right femur is limited due to susceptibility artifact from orthopedic fixation of a subtrochanteric fracture of the proximal femur. On the fat-saturated T2 weighted images there is multifocal abnormal signal intensity throughout the proximal left femur as well as multiple foci of signal abnormality throughout the pelvis, many of which enhance following gadolinium administration. These findings are compatible with diffuse myelomatous disease, although evaluation of interval change is difficult as no prior MR study is available for comparison. Osteoarthritis affects both hip joints and sacroiliac joints, and severe degenerative disc disease affects L5-S1. There is a grade 2 anterolisthesis of L5. There are mild inflammatory changes about the right proximal femur presumably related to rod placement, but we see no fluid collections in the soft tissues to suggest abscess. There is a degenerating uterine fibroid.
Diffuse myelomatous involvement of the bones of the pelvis with particular involvement of the proximal left femur.