Honda Sign and Variants in Patients Suspected of Having a Sacral Insufficiency Fracture

Fujii, Manabu; Abe, Katsumi; Hayashi, Katsumi; Kosuda, Shigeru; Yano, Fumihiko; Watanabe, Sadahiro; Katagiri, Shinako; Ka, Wei Jey; Tominaga, Shin‐ichi

doi:10.1097/00003072-200503000-00004

Cited by 80 publications

(58 citation statements)

References 10 publications

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“…4,31 Variations in the pattern of radiopharmaceutical activity in SIFs include uptake oriented unilaterally in the sacral ala, unilaterally with a horizontal strut, bilaterally without a horizontal strut, and as multiple foci of activity. 34 Posterior planar images are the most sensitive (ie, when the sacrum is closest to the detector). 29 Follow-up scintigraphic results are quite variable, with changes in the radiopharmaceutical uptake pattern during a 10-to 33-month interval, ranging from resolution of abnormal activity to no change or even worsening activity.…”

Section: Nuclear Medicinementioning

confidence: 99%

“…3,9,22,31 Bone scintigraphy has a reported sensitivity of 96% for the detection of SIFs, with a positive predictive value of 92%. 34 Some authors have suggested that characteristic patterns of uptake in the sacrum should be considered diagnostic in the correct clinical context, especially if there are no other sites of abnormal activity in the skeleton and no history of primary malignancy. 33 However, there have been case reports of isolated metastases presenting as unilateral sacral uptake.…”

Section: Nuclear Medicinementioning

confidence: 99%

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Imaging and Treatment of Sacral Insufficiency Fractures

Lyders¹,

Whitlow²,

Baker³

et al. 2009

AJNR Am J Neuroradiol

153

137

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SUMMARY: SIFs are a common, though often unsuspected, cause of low back pain in the elderly. Although numerous radiographic modalities can be used to diagnose SIFs, bone scintigraphy and MR imaging are the most sensitive. Conservative management involves various combinations of bed rest, rehabilitation, and analgesics. More recently, sacroplasty has emerged as an alternative therapy for the treatment of SIFs, with prospective studies and case reports suggesting that it is a safe and effective therapy. This article reviews the imaging appearance of SIFs and discusses treatment options with a focus on sacroplasty.ABBREVIATIONS: FEA ϭ finite-element analysis; MDP ϭ methylene diphosphonate; PMMA ϭ polymethylmethacrylate; SIF ϭ sacral insufficiency fracture; VAS ϭ visual analog pain scale.

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Section: Nuclear Medicinementioning

confidence: 99%

Section: Nuclear Medicinementioning

confidence: 99%

Imaging and Treatment of Sacral Insufficiency Fractures

Lyders¹,

Whitlow²,

Baker³

et al. 2009

AJNR Am J Neuroradiol

153

137

View full text Add to dashboard Cite

show abstract

“…The typical so-called ''Honda'' sign or H-pattern is considered diagnostic of SIF, however it is visible in only up to 40% of cases [10]. Bone scan has a reported sensitivity of 96% for the detection of SIFs [11]. However it might be difficult to differentiate between benign and malignant bone lesions with planar bone scan alone.…”

Section: Discussionmentioning

confidence: 99%

Sacral insufficiency fracture after pelvic radiotherapy: A diagnostic challenge for a radiologist

Lapina¹,

Tiškevičius²

2014

Medicina

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Sacral insufficiency fractures can occur as a complication after pelvic radiotherapy. Despite several recent studies showing high incidence of sacral insufficiency fractures in elderly women after pelvic radiotherapy this condition still remains underdiagnosed. We present a case of sudden onset of low back pain in a female patient with a history of cervical cancer radiotherapy. Initial diagnostic imaging misinterpreted SIF for metastasis. Bone scan and single-photon emission-computed tomography with low-dose computed tomography revealed the correct diagnosis. Due to the reasons that sacral insufficiency fractures still remain underdiagnosed this report is important to practical routine work of oncologists and radiologists.

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“…Some patterns of uptake, such as the BHonda signf or sacral insufficiency fractures can be diagnostic, with sensitivity and positive predictive value of up to 96 and 92 %, respectively (Fig. 5) [52,53].…”

Section: Imagingmentioning

confidence: 99%

Stress fractures: pathophysiology, clinical presentation, imaging features, and treatment options

et al. 2016

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Stress fracture, in its most inclusive description, includes both fatigue and insufficiency fracture. Fatigue fractures, sometimes equated with the term "stress fractures," are most common in runners and other athletes and typically occur in the lower extremities. These fractures are the result of abnormal, cyclical loading on normal bone leading to local cortical resorption and fracture. Insufficiency fractures are common in elderly populations, secondary to osteoporosis, and are typically located in and around the pelvis. They are a result of normal or traumatic loading on abnormal bone. Subchondral insufficiency fractures of the hip or knee may cause acute pain that may present in the emergency setting. Medial tibial stress syndrome is a type of stress injury of the tibia related to activity and is a clinical syndrome encompassing a range of injuries from stress edema to frank-displaced fracture. Atypical subtrochanteric femoral fracture associated with long-term bisphosphonate therapy is also a recently discovered entity that needs early recognition to prevent progression to a complete fracture. Imaging recommendations for evaluation of stress fractures include initial plain radiographs followed, if necessary, by magnetic resonance imaging (MRI), which is preferred over computed tomography (CT) and bone scintigraphy. Radiographs are the first-line modality and may reveal linear sclerosis and periosteal reaction prior to the development of a frank fracture. MRI is highly sensitive with findings ranging from periosteal edema to bone marrow and intracortical signal abnormality. Additionally, a brief description of relevant clinical management of stress fractures is included.

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Honda Sign and Variants in Patients Suspected of Having a Sacral Insufficiency Fracture

Abstract: A "Honda sign or variation" with evidence of fractures elsewhere or no evidence of other metastatic disease should be strong evidence for a sacral insufficiency fracture. The likelihood of having a solitary metastasis to the sacrum is small.

Cited by 80 publications

References 10 publications

Imaging and Treatment of Sacral Insufficiency Fractures

Imaging and Treatment of Sacral Insufficiency Fractures

Sacral insufficiency fracture after pelvic radiotherapy: A diagnostic challenge for a radiologist

Stress fractures: pathophysiology, clinical presentation, imaging features, and treatment options

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