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Heterogeneous Marrow
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Heterogeneous Marrow

Right Hip MRI:  There is a heterogeneous appearance to the bone marrow most notably in the proximal femur but also involving the pelvis as well.  Mild degenerative changes are noted along the acetabulum.  Small amount of physiological fluid is noted with the right hip joint.
MRI Pelvis with & w/out contrast:  There is heterogeneous appearance to the bone marrow most predominantly in the hips.

45 yo female with long standing history of auto-immune disorders, including hemolytic anemia >22 years ago, IgG deficiency treated with IVIG x 12 years, ulcerative colitis x 3 years.  Also, multiple orthopedic injuries, surgeries, s/p lumbar lam L4-5 now with severe DJD and facet arthropathy, s/p total knee arthroplasty right knee.,  Family hx includes father who died of systemic vasculitis, had prostate CA, sarcoidosis, mother with cutaneous vasculitis, eczema, psoriasis, nephey with initial diagnosis of juvenile spondyloarthropathy, now classified as RA (on Enbrel).  1st cousin with stage IV metastatic breast CA, cousins with type I diabetes, Marfan's, lupus, and RA.

My question is, what would your opinion be regarding the MRI findings?  What further workup should be obtained to definitively diagnose the bone marrow changes "which may represent a marrow replacing process"?
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