Radiation Induced Fractures of Sacrum: CT Diagnosis

Rafii, Mahvash; Firooznia, Hossein; Golimbu, Cornelia; Horner, Neil

doi:10.1016/0958-3947(89)90140-4

Cited by 8 publications

(11 citation statements)

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“…The result is the typical Hshaped pattern that has been described [3]. It has been suggested from computed tomographic data that unilateral insufficiency fractures represent an early manifestation that will eventually progress to bilateral fractures [9]. The greater sensitivity of MRI allows the diagnosis of early or minimal unilateral fractures which typically involved the anterior lip of the sacrum (Fig.…”

Section: Discussionmentioning

confidence: 95%

MRI of occult sacral insufficiency fractures following radiotherapy

Mammone

Schweitzer

1995

Skeletal Radiol.

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Following radiation therapy, marrow abnormalities noted on magnetic resonance imaging (MRI) are frequent and may mimic metastases. Specific radiotherapy changes are usually easily identifiable; however, traumatic lesions cause more interpretive difficulties. We assessed the incidence and MRI characteristics of insufficiency fractures in this population. During a 5-year span (1987-1991), 546 patients received pelvic radiotherapy for primary malignancies. MRI was performed in 25 of these patients at least 3 months after treatment. The mean dose in this group was 53 Gy. These MRI scans were retrospectively reviewed for the appearance of the sacrum with particular attention to the presence of insufficiency fractures. This was correlated with clinical course and scintigraphic findings. Presumed insufficiency fractures on MRI paralleled the sacral side of the sacroiliac joint, enhanced with Gd-DTPA, were most prominent or initially seen anteriorly, and had ill-defined margins on all imaging sequences. The incidence of occult sacral insufficiency fractures was at least 20%. Insufficiency fractures of the sacrum in the post-radiotherapy patient are a relatively frequent occurrence which can mimic metastases. Consideration of this phenomenon and knowledge of differential features may avoid overdiagnosis of osseous metastases.

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Section: Discussionmentioning

confidence: 95%

MRI of occult sacral insufficiency fractures following radiotherapy

Mammone

Schweitzer

1995

Skeletal Radiol.

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“…Gas enclosures were visible in ten sacro-iliac joints and questionable in another three. Vacuum phenomenon in the ventral portion of a sacral insufficiency fracture is evident in one patient from the series from Rafii et al [23] and probably in patients reported by Blomlie et al [2], De Smet and Neff [5], and Rafii et al [23]. As only one CT section from each every patient is reproduced, some vacuum phenomena have probably been missed or are not shown due to window level settings or quality of reproduction.…”

Section: Discussionmentioning

confidence: 87%

“…The single most important etiological factor for insufficiency fractures of the sacrum is previous radiation therapy, which makes the bone more fragile [1,2,6,8,23]. Characteristically, these fractures occur bilaterally, but not necessarily at the same time.…”

Section: Discussionmentioning

confidence: 96%

Vacuum phenomena in insufficiency fractures of the sacrum

et al. 1995

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The vacuum phenomenon may be an incidental finding in osteoarthritis of the sacro-iliac joint, but it has not been previously recognized in IFS. The presence of intra-articular vacuum phenomena in the sacro-iliac joints in combination with a sacral fracture and vacuum phenomena located within the sacral fracture supports a diagnosis of insufficiency fracture or may indeed be the clue by which this diagnosis is established.

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“…Characteristic CT findings include fracture lines or areas of sclerosis within the sacral ala parallel to the sacroiliac joints [16]. Frequently, there is anterior cortical disruption of the sacral ala with associated displacement of the fracture fragment.…”

Section: Discussionmentioning

confidence: 99%

“…While MRIs can detect early changes of sacral insufficiency with a reported sensitivity at or near 100%, CTs provide the most specific information for the detection of these fractures and for the exclusion of recurrent malignancy and are extremely useful in confirming equivocal findings on MR imaging. It is now recognized that CT and MRI scans are most useful in identifying insufficiency fractures of the sacrum, that they provide complementary information and that their combined use is ideal [16][17][18]. For the patients in our study all of whom had pre-existing neoplastic disease involving the sacrum, either primary or secondary, both CT and MRI scans were reviewed, where available.…”

Section: Discussionmentioning

confidence: 99%