60-year-old male with history of multiple myeloma, with newly diagnosed FDG avid lesion in the left femur. There is extensive abnormal low T1 signal within the distal right femoral diaphysis, spanning approximately 17 cm in length, with associated increased T2 signal and enhancement. There is marked cortical thickening adjacent to this lesion with associated endosteal scalloping. Increased T2 signal is noted about the periphery of the associated outer cortex.
Enhancing lesion in the distal left femoral diaphysis with associated cortical thickening and endosteal scalloping consistent with the patient's known history of multiple myeloma, although other differential considerations such as metastatic carcinoma are possible.