Large sacral decubitus ulcer, evaluate for osteomyelitis. There is motion degradation on multiple sequences limiting the study. Five lumbar type vertebral bodies are presumed to be present. Compared to 10/29/2011, there is been development of a compression fracture involving the L3 vertebral body with moderate loss of height with minimal retropulsion. There is edema involving the L3 vertebral body extending into the inferior L2 and upper L4 vertebral bodies as well as the intervening disc spaces. There is focus of linear signal void involving the L3 vertebral body which is suspected to represent a vacuum cleft. There is also a mild compression deformity involving the L5 vertebral body with resolution of edema seen on prior MRI. Alignment is within normal limits. The conus medullaris is normal in position. Mild multilevel degenerative changes are seen including mild disc bulges at the L2-L3, L4-L5, and L5-S1 levels without significant spinal canal or neural foraminal stenosis at any level.There is soft tissue thickening and enhancement involving the partially imaged subcutaneous soft tissues in the left upper gluteal region. There is adjacent T1 hypointensity involving the posterior aspect of the left iliac bone with enhancement. This abnormality is seen on the most inferior slices, series 10 axial images 55 and 56.There is mild deformity involving the sacrum at the S2 level which remains unchanged and may be related to remote trauma.Multiple renal cysts again seen.
1. Compared to CT dated 10/2/2015, there has been interval development of a compression fracture involving the L3 vertebral body with linear signal void suggestive of vacuum cleft, which can be seen with avascular necrosis or osteoporotic compression fracture. Signal void can also be seen with cement from vertebroplasty if there is such history, but this seems less likely. There is significant associated edema and enhancement which extends from L2 to L4 which is favored to be reactive to the recent compression fracture. No surrounding paraspinous or epidural fluid collections to suggest infection. If there remains high suspicion for discitis-osteomyelitis at this level, would suggest follow-up imaging.2. Chronic mild compression fracture involving the L5 vertebral body with resolution of edema seen on remote MRI study from 10/29/2011. Chronic fracture/ deformity of the sacrum also again seen.3. Soft tissue thickening and enhancement involving the subcutaneous soft tissues in the left upper gluteal region presumably corresponding to the known decubitus ulcer. There is subtle focus of signal abnormality involving the immediately adjacent left iliac bone which may represent osteomyelitis (axial T1 series 10 image 56). This abnormality is partially imaged with motion degraded sequences and would suggest dedicated MRI pelvis study to more completely image this region for osteomyelitis.