Dual-energy CT as an innovative method for diagnosing fragility fractures of the pelvic ring: a retrospective comparison with MRI as the gold standard

Palm, Hans‐Georg; Lang, Patricia; Hackenbroch, Carsten; Sailer, Lukas; Friemert, Benedikt

doi:10.1007/s00402-019-03283-8

Cited by 41 publications

(45 citation statements)

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“…The fracture morphology of fragility fractures is characterized more by haemorrhage and cortical zones of condensation than by marked cortical discontinuity of the bone [10,19]. As a result, MRI and DECT demonstrate a sensitivity of 100 % for diagnosing fragility fractures of the posterior pelvic ring and are thus clearly superior to CT. (Sensitivity for posterior pelvic ring: 68 %) [6]. In our view and based on our previous studies, DECT can therefore replace MRI entirely for the diagnostic investigation of FFP.…”

Section: Discussionmentioning

confidence: 52%

“…Classic computed tomography is very sensitive when assessing actual interruptions of cortical continuity, both of the posterior and, above all, the anterior pelvic ring. Infractions, however, are difficult to recognise [6] and so fragility fractures of the posterior pelvic ring often go unrecognised because they are less characterised by cortical changes and more by compression lines or bone oedema [10,19].…”

Section: Discussionmentioning

confidence: 99%

“…As regards fracture classification, CT in many cases generally reaches a different fracture classification level in comparison with DECT and MRI [6]. Especially bilateral lesions of the sacrum are not diagnosed to their full extent or are overlooked [6]. With the high sensitivity of MRI and DECT, fractures located at the posterior pel- vic ring, which were previously regarded as only unilateral using CT and x-ray, were diagnosed to their full extent and, above all, are now also often recognised as bilateral lesions.…”

Section: Discussionmentioning

confidence: 99%

“…Unlike high-velocity fractures of the pelvis in young patients, where computed tomography (CT) is the most important imaging modality, there have been developments in the diagnostics of fragility fractures in recent years regarding imaging, with increased use of magnetic resonance imaging (MRI) [6]. Until recently, MRI was the imaging technique with the by far highest sensitivity [7].…”

Section: Diagnostic Imaging For Fragility Fractures Of the Pelvismentioning

confidence: 99%

“…The advantages of this technique over MRI are fast availability and cost-effective application, combined with a good demonstration of the bony state of the fracture [10]. As regards detection of fragility fractures of the pelvis, DECT has exactly the same sensitivity and specificity as MRI at 100 % [6]. Therefore, two very sensitive diagnostic imaging modalities are available in the form of MRI and DECT for identifying bone marrow oedema and diagnosing fragility fractures of the pelvis.…”

Section: Diagnostic Imaging For Fragility Fractures Of the Pelvismentioning

confidence: 99%

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Fragility Fractures of the Pelvic Ring – Does the Evidence of Oedema Lead us to More Surgeries?

et al. 2020

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Introduction The choice of therapy for fragility fractures of the pelvis (FFP) is largely determined by the diagnosed fracture morphology. It is now unclear whether the change in diagnostic options – sensitive detection of fracture oedema in the sacrum using MRI and dual-energy computed tomography (DECT) – has an impact on the therapeutic consequences. The aim of this retrospective study was therefore to evaluate the change in the diagnostics used and the resulting therapy regimen in our patient population. Materials and Methods We performed a monocentric-retrospective analysis of 196 patients with a fragility fracture of the pelvis in our clinic (national TraumaZentrum® DGU and SAV approval) in the period from 2008 to 2017. We examined changes in epidemiology, diagnostics/classification and therapy of the pelvic ring fractures treated by us. Results The diagnostic procedures used are subject to a clear change towards oedema detection using MRI and DECT. The graduation has changed towards more severe forms of fracture after FFP. There is now also an increasing proportion of patients treated by surgery (2008 – 2009: 5.3% vs. 2015 – 2017: 60.3%). Conclusion We were able to show that the introduction of sensitive diagnostic procedures coincided with a higher classification of the fractures. It is also noteworthy that the increase in operations is not only due to a higher degree of classification; also in relative terms, more patients are operated on within type FFP II.

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Section: Discussionmentioning

confidence: 52%

Section: Discussionmentioning

confidence: 99%