PET/MRI is useful for early detection of pelvic insufficiency fractures after radiotherapy for cervical cancer

Abstract

Radiotherapy (RT) is used to manage cervical cancer, and pelvic insufficiency fracture (PIF) is known as a late complication of RT. The present study identified risk factors for PIF after radiotherapy for cervical cancer, and investigated its incidence rate. It also considered the usefulness of positron emission tomography/magnetic resonance imaging (PET/MRI) in PIF diagnosis. A total of 149 patients with cervical cancer who received definitive or adjuvant RT with/without concurrent chemotherapy between January 2013 and December 2018 were investigated in the present study and followed up for more than one month after RT at Kobe University Hospital. The median follow-up period was 32 months (range, 1-87 months), and the median age of all patients was 66 years (age range, 34-90 years). Computed tomography (CT), MRI, PET/CT or PET/MRI were used for image examination. Among the 149 patients, 31 (20.8%) developed PIF. The median age of these patients was 69 years (age range, 44-87 years). Univariate analysis using the log-rank test demonstrated that age (≥60 years) was significantly associated with PIF. The median maximum standardized uptake value of PIF sites on PET/CT was 4.32 (range, 3.04-4.81), and that on PET/MRI was 3.97 (range, 1.21-5.96) (P= 0.162). Notably, the detection time of PIF by PET/MRI was significantly earlier compared with PET/CT (P<0.05). The incidence of PIF after RT for cervical cancer was 20.8%, and age was significantly associated with risk factors for such fractures. Taken together, these results suggest that PET/MRI, which offers the advantage of decreased radiation exposure to the patient, is useful for diagnosing PIF and can detect it earlier than PET/CT imaging.

Effects of Radiation Therapy and Chemotherapy on the Musculoskeletal System

“…PET/MRI offers the advantage of its excellent anatomical resolution added to the functional study. PET/MRI was able to demonstrate the onset of a pelvic fracture in the context of irradiation earlier than PET/CT, 26 with the potential to allow early intervention.…”

“…The incidence of radiotherapy-induced pelvic insufficiency fractures was reported to be 2.7 to 89% in a 2018 systematic review, 1 with a reported incidence for sacral involvement of at least 20%. 26 In patients with osteoporosis, the risk of fracture after radiotherapy is increased (e.g., in postmenopausal women, with a prevalence of up to 34%). 27 Their configuration is typical, parallel to the sacroiliac joints, with ill-defined margins in all sequences.…”

Significance of Magnetic Resonance Imaging Combining with Detection of Serum HE4, TSGF, and CD105 Levels in Diagnosis and Treatment of Moderate to Advanced Cervical Cancer

“…According to a survey report by the World Health Organization in 2018, the incidence and mortality of cervical cancer worldwide is related to the changes in China's social environmental factors as well as the improved diagnostic techniques. Currently, the number of patients who die each year due to cervical cancer in China is above 50,000, accounting for approximately 18.4% of all deaths from female malignancies [5,6], indicating that the disease is seriously endangering the life health of Chinese women. Performing treatment measures to patients according to clinical stages while actively detecting the treatment effect is key to improving the prognosis of cervical cancer, and in particular, the accuracy of staging in patients with moderate to advanced cervical cancer will directly affect the selection and formulation of treatment options for them.…”