Clinical History: 56-year old woman with right leg pain for 10 months

Diagnosis: Multiple myeloma

MR Technique:

Imaging of the right lower extremity was performed on a 3T MR system. (A) Coronal T2-weighted TIRM (TR/TE 3000/38ms), (B) sagittal T2-weighted TIRM (TR/TE 3000/38), (C) axial T1-weighted TSE, and (D) axial T2-weighted TSE with Dixon fat suppression (TR/TE 2600/90) were acquired before the administration of intravenous contrast. Thereafter, (E) TWIST MRA (TR/TE 2.9/1.06ms) and (F, G) contrast-enhanced T1-weighted TSE (TR/TE 700/11ms) images were acquired in three orthogonal planes with Dixon fat suppression.

Imaging Findings:

There is an irregular, predominantly intra-medullary lesion in the superior aspect of the mid right tibia. Cortical breakthrough is present anteriorly with associated soft tissue edema. On pre-contrast MRI, the lesion demonstrates high signal intensity on T2WI and intermediate to slightly high signal intensity on T1WI. Dynamic MRA demonstrates increased blood flow to the lesion, and the lesion exhibits homogenous enhancement on delayed contrast-enhanced images.