Magnetic resonance imaging of para-acetabular insufficiency fractures in patients with malignancy
| Autor: | Mark E. Schweitzer, Donald Resnick, Y. Kakitsubata, Daphne J. Theodorou, Stavroula J. Theodorou |
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| Rok vydání: | 2006 |
| Předmět: |
Adult
Male medicine.medical_specialty Bone disease Radiography Pain Bone Neoplasms Malignancy Diagnosis Differential Fractures Bone medicine Insufficiency fracture Humans Radiology Nuclear Medicine and imaging Aged Aged 80 and over Stress fractures medicine.diagnostic_test business.industry Soft tissue Acetabulum Magnetic resonance imaging General Medicine Middle Aged medicine.disease Magnetic Resonance Imaging Female Radiology Differential diagnosis business |
| Zdroj: | Clinical Radiology. 61:181-190 |
| ISSN: | 0009-9260 |
| DOI: | 10.1016/j.crad.2005.10.003 |
| Popis: | AIM: To describe the characteristic magnetic resonance imaging (MRI) findings of para-acetabular insufficiency fractures in patients with malignancy, and compare the MRI appearance of these fractures with that of metastatic bone disease. MATERIALS AND METHODS: MRI examinations were reviewed in 16 patients with a known malignant tumour and severe hip pain that raised the possibility of local recurrence or metastatic disease. Six patients had received pelvic irradiation, and three patients were receiving steroid medication. RESULTS: The total number of fractures detected was 21: a solitary fracture was present in 11 patients and five patients had bilateral para-acetabular fractures. Two patients had associated sacral insufficiency fractures, and one of them had stress fractures involving both acetabular columns. Conventional radiography allowed the diagnosis of 14 (67%) fractures; six (28%) radiographic examinations were negative; and one (5%) examination was equivocal for fracture. Available scintigraphic and computed tomography (CT) studies revealed typical findings of fracture. Using MRI, insufficiency fractures appeared as linear regions of low signal intensity on T1- and T2-weighted images. Marked marrow oedema was evident in all cases. Fractures characteristically were parallel to the superior acetabulum in a curvilinear fashion in 18 (86%) instances, and were oblique in three (14%) instances. The fractures demonstrated considerable enhancement after intravenous gadolinium administration. No associated soft tissue masses were documented. CONCLUSION: Para-acetabular insufficiency fractures are a cause of hip pain, which may mimic skeletal metastasis in the patient with malignancy and pelvic irradiation. Recognition of the characteristic MRI findings of these fractures can preclude misdiagnosis and unnecessary bone biopsy. |
| Databáze: | OpenAIRE |
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