Magnetic resonance appearance of sacral insufficiency fractures

Abstract

Insufficiency fractures of the sacrum are a commonly recognized form of stress fracture typically occurring in elderly patients. As such patients usually present with low back pain, MR imaging is often performed initially as a means of evaluation. We present 5 patients with sacral insufficiency fractures imaged with MR. Metastatic disease was a leading clinical suspicion as all patients were elderly and three had known primary neoplasms. T1-weighted sequences demonstrated bands of decreased signal intensity, usually paralleling the sacral aspect of the sacroiliac joints and occasionally occurring as a horizontal band across the sacral body. Four of five patients underwent further evaluation with computed tomography (CT) or nuclear bone scanning, which confirmed the diagnosis of sacral insufficiency fracture. We conclude that MRI is sensitive but not specific in detecting sacral insufficiency fractures. As MR imaging is rapidly becoming the method of choice for evaluating back pain, it is important to consider this diagnosis in elderly persons.

Sacral stress fracture during pregnancy-a case report

“…They are mostly reported in athletes or in osteoporotic patients (Hoang et al 1988, Brahme et al 1990, McFarland and Giangarra 1996. To our knowledge, only one case has been described occurring during pregnancy and this was in a woman who gained 20 kg (Hoang et al 1988).…”

“…Radionuclide bone scan and MRI have the highest sensitivity (Hoang et al 1988, Brahme et al 1990, Albertsen et a1.1995, McFarland and Giangarra 1996. On bone scan, the characteristic "butterfly" sign is seen in bilateral cases.…”

“…On MRI a stress fracture is difficult to distinguish from a malignancy or infection on T1-sequences (Hoang et al 1988, Brahme et al 1990, McFarland and Giangarra 1996. Therefore we used the T2-weighted Turbo Inversion Recovery Sequences.…”

Imaging and Treatment of Sacral Insufficiency Fractures

“…35 Marrow edema is demonstrated as areas of increased signal intensity on T2-weighted and inversion-recovery images and low signal intensity on T1-weighted images. 28,35,38 A hypointense fracture line is usually evident within the area of edema, though it is not seen in 7% of cases (Fig 7). 35 Coronal oblique images in the plane of the sacrum better demonstrate the vertically oriented fractures and should be included in the imaging protocol if there is clinical suspicion (Fig 7).…”

Olgu Sunumu: Osteoporoz Zemininde Gelişmiş Lomber Spinal Patolojiyi Taklit Eden Bir Sakral Yetersizlik Kırığı

“…Bilindiği gibi MRG, bel ağrısını tanımada, spinal yapıları ve kemik iliğindeki değişikliği saptamada duyarlı bir görüntüleme metodu olarak tercih edilir (11). Ancak MRG'nin, yüksek hassasiyeti olmasına rağmen klinik bulgularla uyumlu olmadığı MRG, aynı zamanda kırıkların inflamasyon ve onarımı sonucu gelişen kemik iliği ödemini saptayabilir (6).…”