51-year-old female with a history of neurosarcoidosis and lesions in multiple pelvic bones, Osteonecrosis of the bilateral femoral heads. Again seen are multiple round lesions within the sacrum, innominate bones, and proximal femora, overall appearing more extensive compared to the prior exam. In particular, the right subtrochanteric lesion represents greater than 50% of the cross sectional area. These lesions are largely isointense (or perhaps slightly hyperintense) to skeletal muscle on T1, hyperintense on T2, and enhance following contrast administration. Osteonecrosis of the femoral heads appears similar to the prior exam. Moderate to severe degenerative disk disease is noted at L4-5. There is a small amount of fluid in the SI joints, but no enhancement to suggest inflammatory arthritis. There is no hip joint effusion or frank synovitis. Prominent retroperitoneal, iliac, and inguinal lymph nodes are again noted. The inguinal nodes appear slightly larger compared to the prior exam. Uterine fibroids and nabothian cysts are noted.
1.Multiple bone lesions appearing more extensive overall compared to the prior exam. The differential diagnosis remains metastatic disease, multiple myeloma, and granulomas of sarcoid. 2.Stable femoral head osteonecrosis and other findings as described above.3.Slight interval enlargement of the inguinal lymph nodes.