Magnetic Resonance Imaging in Pelvic Fractures – Part 1: Which Criteria Lead Us to Supplementary MRI Diagnostics?

Abstract

Introduction Isolated pelvic fractures are relatively rare with an incidence of 3 – 6% of all fractures, but their incidence in polytraumatized individuals increases to 25%. The S3 guideline Polytrauma gives a clear recommendation for diagnostics by means of pelvic radiography (X-ray) and computed tomography (CT). A recommendation for the diagnosis by means of magnetic resonance tomography (MRI) especially in patients with low energetic/missing trauma does not currently exist. It is unclear on the basis of which criteria the MRI can be indicated in pelvic fractures. The aim of our study was therefore to retrospectively record indications for the indication of MRI in pelvic fractures – with adequate as well as inadequate trauma. Material and Methods In a retrospective clinical study, a total of 140 patients (median 68 years, range 15 – 97, 75 female, and 66 male) with a pelvic fracture were included in the study over a period of three years. Overall, the trauma mechanism revealed 73 adequate and 67 inadequate fractures. 31/140 patients had undergone MRI of the pelvis in addition to a CT/X-ray scan. The two subgroups “with MRI” and “without MRI” were analyzed with regard to the parameters “sex”, “age”, “adequacy of the trauma”, “fracture localization”, “duration of admission to imaging”, “type of therapy” and “duration to surgery” compared. Results It was shown that the MRI diagnosis was performed especially in female, elderly patients (81 years, range 19 – 94 years). Patients with inappropriate trauma have received MRI more frequently (74%) than patients with adequate trauma (26%). With regard to fracture localization no differences could be shown. The MRI was performed on a median 4 days after the CT examination. Regarding the decision “conservative” vs. “operationally” our two groups without and with MRT tended to differ not. Patients with MRI were operated on median 2 days later than patients who did not receive MRI. Conclusions Pelvic fracture MRI should be performed primarily in elderly female patients without adequate trauma. In patients with adequate trauma, MRI is of low value, especially as MRI diagnostics are performed with delay, resulting in later surgery.

Insufficiency Fractures vs. Low-Energy Pelvic Ring Fractures – Epidemiological, Diagnostic and Therapeutic Characteristics of Fragility Fractures of the Pelvic Ring

“…The diagnosis of insufficiency fracture in FFP is complicated by the fact that there is no definitive guideline. As a result, sensitive imaging (MRI/DECT) is usually delayed by 3 – 4 days following hospitalisation 32 , 33 . All these factors can result in a certain latency when diagnosing insufficiency fractures of the pelvic ring.…”

“…Erschwerend kommt bei der Diagnose der Insuffizienzfraktur als der Teil der FFP hinzu, dass sie ohne klare Leitlinie erfolgt. Dadurch erfolgt die Durchführung einer sensitiven Bildgebung (MRT/DECT) meist mit 3 – 4 Tagen Verzögerung nach der stationären Aufnahme 32 , 33 . All diese genannten Faktoren können dazu führen, dass die Diagnose einer Insuffizienzfraktur des Beckenrings erst mit einer gewissen zeitlichen Latenz erfolgt.…”

The Role of MRI and CT Scan in Classification and Management of Pelvic Fractures: A Systematic Review

“…Besides, the elderly population may have implants or medical devices that prevent them from using MRIs. In the present review, two of the included studies assessed MRI in comparison to CT among the elderly [ 15 , 16 ]. The results suggest that MRI has no added value to CT in diagnosing fractures in this population.…”

Sakrumfrakturen – Epidemiologie und Diagnostik

“…In einer retrospektiven Studie haben wir uns daher der Frage gewidmet, welche Kriterien uns in der eigenen Klinik zur ergänzenden MRT-Diagnostik veranlasst haben [18].…”