Reason: new L hip pain, eval for new mets History: above Post contrast images are not able to be obtained due to the patient's inability to tolerate further examination. Note is made of decreased bone marrow signal abnormality affecting the imaged portions of the L3 and L4 vertebrae on both T1 weighted images and fluid sensitive sequences. There is also decreased bone marrow signal abnormality along the right acetabulum which extends into the right ilium, abutting the right sacroiliac joint. There is also decreased signal abnormality on T1-weighted images and fluid sensitive sequences within the left ilium about the left sacroiliac joint. Given the diffuse decreased signal abnormality on all pulse sequences, these findings may represent treated metastases, although these are incompletely characterized due to lack of contrast enhanced imaging. There is restricted diffusion within the left ilium, left acetabulum, left ischium, left pubic bone, and left femoral head/neck extending to the level of the intertrochanteric and subtrochanteric regions of the femur. There is also diffuse restricted diffusion within the sacrum.
Limited examination due to lack of contrast enhanced images. However, there are multiple foci of restricted diffusion affecting the bones of the left hemipelvis and left femur which are suspicious for osseous metastasis, although these are incompletely characterized on this noncontrast examination. Multiple foci of decreased signal abnormality on all pulse sequences within the right acetabulum, ilium and ischium may represent treated metastases, although these are also incompletely characterized on this noncontrast examination.