Imaging of pelvic insufficiency fractures.

Peh, Wilfred C.G.; Khong, Pek Lan; Yin, Yuming; Ho, Wai Yin; Evans, N.; Gilula, Louis A.; Yeung, Henry; Davies, A. M.

doi:10.1148/radiographics.16.2.8966291

Cited by 137 publications

(79 citation statements)

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“…35 Radiation-induced fractures generally require symptomatic management by Steps 1 (nonsteroidal anti-inflammatory drugs (NSAIDs), paracetamol) or 2 (weak opioids) analgesics and rest. 11,[36][37][38][39][40][41] In some cases, pain control requires specialized management and/or hospitalization. 11,12 The management of osteoporosis is particularly important in these patients who are postmenopausal treated with radiotherapy.…”

Section: Discussionmentioning

confidence: 99%

Pelvic insufficiency fracture (PIF) incidence in patients treated with intensity-modulated radiation therapy (IMRT) for gynaecological or anal cancer: single-institution experience and review of the literature

Bazire

Foy

et al. 2017

BJR

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Objective: To summarize the results of pelvic insufficiency fracture (PIF) incidence in patients with anal or gynaecological cancer treated by pelvic intensitymodulated radiation therapy (IMRT). Methods: The clinical and morphological (CT and/or pelvic MRI) characteristics of patients treated by IMRT at our institution between 2007 and 2014 were analyzed. The global incidence of PIF after external beam radiotherapy and the impact of tumour site (gynaecological or anal cancer) were determined. A dosimetric study was then performed to compare patients with and without pelvic fracture. Results: 341 patients were treated by IMRT for gynaecological or anal cancer between 2007 and 2014. 15 patients experienced at least 1 pelvic fracture after external beam radiotherapy, corresponding to an overall incidence of 4.4%. Age and menopausal status were correlated with an increased fracture risk (p 5 0.0274 and p , 0.0001, respectively). The site of the primary tumour (gynaecological or anal canal) was not associated with an excess fracture risk. The median maximum dose received at the fracture site was 50.3 Gy (range: 40.8-68.4 Gy). Conclusion: The incidence of pelvic fracture after IMRT is low, but is higher after the age of 50 and in patients who are postmenopausal. Pre-treatment evaluation of bone density by bone densitometry and phosphorus-calcium assessment could be useful prior to the management of these patients. Advances in knowledge: Pelvic fractures are a frequent complication after radiotherapy. The influence of IMRT and clinical characteristics were evaluated in this study.

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Section: Discussionmentioning

confidence: 99%

Pelvic insufficiency fracture (PIF) incidence in patients treated with intensity-modulated radiation therapy (IMRT) for gynaecological or anal cancer: single-institution experience and review of the literature

Bazire

Foy

et al. 2017

BJR

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“…29,30 Occasionally, cortical disruption and/or fracture lines may be evident. 31 In one meta-analysis, sclerosis was reported in 57% of patients, with a fracture line evident in only 12.5%.…”

Section: Plain Filmsmentioning

confidence: 99%

“…34 Posterior planar images are the most sensitive (ie, when the sacrum is closest to the detector). 29 Follow-up scintigraphic results are quite variable, with changes in the radiopharmaceutical uptake pattern during a 10-to 33-month interval, ranging from resolution of abnormal activity to no change or even worsening activity. 3,9,22,31 Bone scintigraphy has a reported sensitivity of 96% for the detection of SIFs, with a positive predictive value of 92%.…”

Section: Nuclear Medicinementioning

confidence: 99%

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Imaging and Treatment of Sacral Insufficiency Fractures

Lyders¹,

Whitlow²,

Baker³

et al. 2009

AJNR Am J Neuroradiol

154

137

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SUMMARY: SIFs are a common, though often unsuspected, cause of low back pain in the elderly. Although numerous radiographic modalities can be used to diagnose SIFs, bone scintigraphy and MR imaging are the most sensitive. Conservative management involves various combinations of bed rest, rehabilitation, and analgesics. More recently, sacroplasty has emerged as an alternative therapy for the treatment of SIFs, with prospective studies and case reports suggesting that it is a safe and effective therapy. This article reviews the imaging appearance of SIFs and discusses treatment options with a focus on sacroplasty.ABBREVIATIONS: FEA ϭ finite-element analysis; MDP ϭ methylene diphosphonate; PMMA ϭ polymethylmethacrylate; SIF ϭ sacral insufficiency fracture; VAS ϭ visual analog pain scale.

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“…Bizim olgumuzda da bilateral pubik ve iliak kırık birlikteydi. Kırıklar genellikle radyonüklid kemik sintigrafisinde artmış tutulum gösterirken bu hem sakral ala ve hem de vücudun yatay bileşeninin katıldığı kelebek veya H işareti olarak tanımlanır (9). Bizim olgumuzda da kemik sintigrafisinde pelviste kelebek veya H işareti belirgindi.…”

Section: Discussionunclassified

Bilateral Avascular Necrosis and Pelvic Insufficiency Fractures Developing after Pelvic Radiotherapy in a Patient with Prostate Cancer: A Case Report

Sarı¹,

Örnek²,

Sucuoğlu³

et al. 2016

Tod

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SummaryProstate cancer is one of the most common malignancies in men. Pelvic radiotherapy is commonly used in both radical and palliative treatment for prostate cancer. Radiation-induced adverse effects might be seen on adjacent healthy tissues (such as vessels, bones and soft tissues) with the exception of targeted area. Particularly several years after radiotherapy, low back and hip pain may occur due to bone edema, necrosis or fractures. In these cases, whether complaints due to the degenerative, metastatic or radiotherapy complications must be examined and appropriate treatment should be arranged. For this purpose, we present our elderly patient who received radiotherapy for prostate cancer, and thereafter, developed bilateral avascular hip necrosis and pelvic insufficiency fractures. Keywords: Prostate cancer, radiotherapy, pelvic, insufficiency fracture, avascular necrosis Prostat Kanseri Radyoterapisi Sonrası Gelişen Femur Başı Avasküler Nekrozu ve Pelvik Yetersizlik Kırığı Olgusu Bilateral Avascular Necrosis and Pelvic Insufficiency Fractures Developing after Pelvic Radiotherapy in a Patient with Prostate Cancer: A Case ReportProstat kanseri, erkeklerde en sık görülen malignitelerden biridir. Pelvik radyoterapi, radikal veya palyatif prostat kanseri tedavisinde yaygın olarak kullanılmaktadır. Radyoterapi, hedef kanser bölgesi dışındaki komşu sağlam dokularda (damar, sinir, kemik gibi) komplikasyonlar meydana getirebilir. Özellikle radyoterapiden yıllar sonra ortaya çıkabilen kemiklerde ödem, nekroz veya kırıklara bağlı bel ve kalça ağrıları meydana gelebilir. Bu olgularda şikayetlerin dejeneratif, metastatik veya radyoterapi komplikasyonuna mı bağlı olduğu tetkik edilmeli ve tedavi buna göre düzenlenmelidir. Biz de bu amaçla, prostat kanserinde pelvik radyoterapi uygulanan ve buna bağlı bilateral kalça avasküler nekrozu ve pelvik yetersizlik kırıkları gelişen yaşlı erkek hastamızı sunuyoruz.

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Imaging of pelvic insufficiency fractures.

Cited by 137 publications

References 0 publications

Pelvic insufficiency fracture (PIF) incidence in patients treated with intensity-modulated radiation therapy (IMRT) for gynaecological or anal cancer: single-institution experience and review of the literature

Pelvic insufficiency fracture (PIF) incidence in patients treated with intensity-modulated radiation therapy (IMRT) for gynaecological or anal cancer: single-institution experience and review of the literature

Imaging and Treatment of Sacral Insufficiency Fractures

Bilateral Avascular Necrosis and Pelvic Insufficiency Fractures Developing after Pelvic Radiotherapy in a Patient with Prostate Cancer: A Case Report

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