sb/ke/rg/nl
Date : 00.00.00

Name of the Patient : Abc Xyz lmn / F / 52 yrs.
Referred by : Dr. Abc Xyzchale / Dr. Abc Xyzmpat.
Examination : M.R.I. of Both Hips.

CLINICAL PROFILE :

C/O multiple myeloma detected in March 0000. Received 9 cycles of chemotherapy.
C/O backache since April 0000 with limping.

EXAMINATION :

M.R.I of both hips was performed using the following parameters :

6 mm thick T1 Proton and T2 Weighted axial (with fat saturation)
images.
5 mm thick T1 Weighted and STIR coronal images.

8 mm thick T2 Weighted axial (with fat saturation) images through the proximal thighs.

The lumbo-sacral spine was screened with 5 mm thick T1 Weighted sagittal images.

OBSERVATION :

There is seen a fairly large, approximately 6.0 x 7.0 x 7.0 cms sized intermediate signal intensity mass lesion on the T1 Weighted images in the left iliac bone medially adjacent to the left sacro-iliac joint. This lesion appears hyperintense on the T2 Weighted images. Resultant destruction of the left iliac bone adjacent to the left sacro-iliac joint is noted. Probable extension of the lesion into the left sacro-iliac joint per se is noted. The sacrum is however not involved. Inferiorly the lesion is seen to extend upto the roof of the left acetabulum. There is however no extension into the left hip joint per se. Soft tissue component of the lesion is seen to extend deep to the left ilio-psoas muscle along the left iliac wing. Slight extension into the posterior soft tissues deep to the left gluteal muscles is also noted.
..2/.






A focal hypointense signal on T1 Weighted images is noted in the right ischial bone and in the L5 vertebral body on the left which appears hyperintense on the STIR images (scans 105.9 & 104.9, 106.2 & 107.2)).

The visualized right hip joint per se is otherwise unremarkable.

The left femoral head and proximal shafts are also unremarkable.

The rest of the visualized bones of the pelvis show spotty fatty marrow changes. Slight atrophy of the left gluteal muscle is noted as compared to the right.

The proximal right thigh appears slightly increased in diameter as compared to the left. There is an ill-defined hyperintense signal on the T2 Weighted and STIR images in the subcutaneous fat and along the fatplanes in the anterior compartment of the proximal right thigh. This signal is hypointense to normal fat on the T1 Weighted images. Probable intraluminal signal is noted in the proximal right femoral vein.

Screening images of the lumbar spine do not reveal any significant feature of note, except for altered signal in the L5 vertebral body.

IMPRESSION :

A fairly large, approximately 6.0 x 7.0 x 7.0 cms sized mass lesion in the left iliac bone, medially with erosion of the left iliac bone and soft tissue extensions as described represents a myelomatous deposit. Focal lesion in the right ischium and in the L5 vertebral body on the left are also myelomatous deposits. As compared to the previous MRI dated 00.00.00, there is increase in the size of the left iliac bone lesion. The lesions in the right ischium and L5 vertebral body appear to be new lesions.

Altered signal along the fat planes in the anterior compartment of the proximal right thigh may represents cellulitis. Intraluminal signal in the proximal right femoral vein is suspicious for a thrombus (this however needs to be confirmed).