Reason: sarcoid with worsening pain, want to assess for progression History: sarcoid with worsening pain, want to assess for progression Again seen are multiple lesions within the innominate bones, sacrum, and proximal femora compatible with the stated history of osseous sarcoid. Many of these lesions now show high signal intensity on T1-weighted images indicating fatty replacement and healing. For example, the reference right intertrochanteric lesion measures approximately 2 cm in its greatest dimension which previously demonstrated homogeneous signal abnormality now appears predominantly fatty on the T1-weighted images. Other lesions appear slightly larger on the current study than on the prior examination. For example, a lesion within the proximal left femur measures approximately 1.5 cm in its greatest transverse dimension, previously measuring 1 cm. New lesions are also identified, for example, in the left anterior column of the left acetabulum. Many of these lesions show enhancement following gadolinium administration. There is osteonecrosis of both femoral heads with progression of flattening of the anterior surface of the left femoral head. Osteoarthritic changes of the hips have also progressed slightly on the left as well. There is slight enlargement of the bilateral inguinal lymph nodes which still retain their normal fatty hilum. Degenerative disc disease affects the imaged lumbar spine. Please refer to the dedicated lumbar spine MRI report for additional details. Note is made of left hip synovitis appearing similar to the prior study.
Osseous sarcoid as described above with a mixed pattern of response, with some lesions showing fatty replacement and others showing slight enlargement. A few new lesions are also identified.