Medical Imaging Analysis Report

1. Imaging Findings

Based on the CT and MRI images provided by the patient, the following main features are observed:

• Multiple well-defined soft tissue density or signal lesions are seen near the sacroiliac joint and in the sacral region. On CT, localized bony destruction is noted at the lesion sites, with a certain degree of sclerotic rim surrounding it (“bone lysis with sclerotic margin”).
• On MRI, these lesions appear isointense or slightly hypointense on T1-weighted images (T1-WI), iso- to hyperintense on T2-weighted images (T2-WI), and show marked enhancement after contrast administration.
• Some areas within the lesions show heterogeneous signals, suggesting possible cystic changes or mild hemorrhage, calcification, and other degenerative pathological changes.
• The lesion presents as a mass-like formation with a smooth contour, and no obvious evidence of surrounding tissue infiltration is observed.

2. Differential Diagnosis

Based on the patient’s past medical history (previous surgery for a schwannoma in the right iliac region, multiple follow-ups thereafter) and the imaging features, the following differential diagnoses are considered:

1. Multiple Schwannomas (Schwannomatosis)
   Rationale: The patient has multiple lesions, and histopathological examinations have confirmed tumors derived from the nerve sheath. Brain MRI ruled out acoustic neuroma, which aligns with the diagnostic features of schwannomatosis.
2. Neurofibroma
   Rationale: This also belongs to the group of peripheral nerve sheath tumors. Its imaging appearance can be similar to schwannomas, necessitating pathological examination to differentiate.
3. Other destructive bone lesions (e.g., lymphoma, giant cell tumor, etc.)
   Rationale: Certain destructive bone or periarticular lesions may present with some similar imaging findings. However, given the patient’s long-standing history of schwannomas, these conditions are less likely.

3. Final Diagnosis

Considering the patient's age, prior history of multiple schwannomas and post-surgical status, current imaging findings (multiple solid lesions located along peripheral nerve paths with bone lysis and a sclerotic rim), and the exclusion of acoustic neuroma meeting the diagnostic criteria for Schwannomatosis. Pathological examination also confirms a nerve sheath origin. Therefore, the most probable final diagnosis is:

Multiple Schwannomas (Schwannomatosis)

4. Treatment Plan and Rehabilitation

1. Treatment Strategy

Surgical Treatment: For lesions causing significant symptoms (e.g., localized pain, nerve compression, functional impairment) or bony destruction affecting spinal stability, surgical resection or decompression is considered. For moderately sized lesions with slow growth and mild symptoms, treatment decisions can be tailored based on patient preference and a risk-benefit evaluation, including selective surgery or observation.
Conservative and Pharmacological Treatment: If lesions remain relatively stable and symptoms are manageable, regular follow-up and monitoring of lesion changes are recommended. For pain or mild functional impairment, the use of analgesics, nerve-modulating drugs (e.g., gabapentin), and physical therapy modalities can help relieve symptoms.
Other Interventions: In cases of potential nerve compression or higher risk of recurrence, an assessment of radiation therapy or newer treatments (such as stereotactic radiosurgery) may be considered. However, schwannomas are generally less sensitive to radiotherapy, so a combined assessment with surgical options is necessary.

2. Rehabilitation and Exercise Prescription

Considering that the patient has undergone multiple surgeries, and that the affected areas include spinal and joint structures, rehabilitation exercise must be gradual and individualized.

1. Early Recovery Phase:
   • Main goals include promoting surgical wound healing, improving local blood circulation, and preventing muscle atrophy.
   • Low-intensity isometric exercises can be performed (e.g., static contractions of the lower limbs), or light core activation exercises (such as modified plank) under protective bracing/support.
   • Frequency: 3-4 times weekly; Intensity: below 50% of the individual’s maximum tolerance; Duration: 10-15 minutes each session; Modality: isometric training and simple exercises with assistive devices.
2. Intermediate Strengthening Phase:
   • Once the wound has healed and pain is generally controllable, emphasis can be placed on core stability and joint range-of-motion exercises (e.g., partial bridge exercise, resistance band stretching for the lower limbs).
   • Progressively incorporate muscle strengthening and cardiorespiratory endurance exercises (e.g., brisk walking in short steps, stationary cycling with low impact).
   • Frequency: 3-5 times weekly; Intensity: 50-70% of the individual’s maximum tolerance; Duration: 20-30 minutes each session; Modality: a combination of aerobic and core strength exercises, with careful attention to proper form and safety.
3. Late Consolidation Phase:
   • Include more functional training, such as balance training on a wobble board or water-based exercises under professional guidance. If the lesions remain stable, gradual progression to appropriate weight-bearing exercises can be considered.
   • Frequency: 3-5 times weekly; Intensity: maintain moderate intensity and gradually increase to 70-80% of the individual’s maximum tolerance; Duration: 30-45 minutes each session; Modality: multi-joint and multi-muscle group exercises.
4. Precautions:
   • Regular imaging follow-up is necessary to monitor lesion changes. If significant pain or worsening neurological symptoms occur, medical evaluation is required immediately.
   • If the patient has comorbidities or reduced cardiopulmonary function, the intensity and duration of aerobic exercise should be adjusted accordingly.

Disclaimer: This report is a reference analysis based on the available imaging and clinical information. It does not replace in-person diagnosis or consultation by professional medical institutions. Specific treatment and rehabilitation plans should be tailored to the patient’s actual condition and confirmed by specialists and rehabilitation therapists.