Use of SPECT/CT with 99mTc-MDP Bone Scintigraphy to Diagnose Sacral Insufficiency Fracture

Al-faham, Zaid; Rydberg, John; Wong, Ching-Yee Oliver

doi:10.2967/jnmt.114.137547

Cited by 12 publications

(7 citation statements)

References 4 publications

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“…IF usually shows increased uptake on bone scan (BS), and the “Honda sign or its variation” (H-sign) is well-known as a characteristic sign of a sacral IF (12, 13). However, the “H-sign” is not always present.…”

Section: Introductionmentioning

confidence: 99%

Characterization of Insufficiency Fracture and Bone Metastasis After Radiotherapy in Patients With Cervical Cancer Detected by Bone Scan: Role of Magnetic Resonance Imaging

Zhong

Zhang

et al. 2019

Front. Oncol.

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Background: Insufficiency fracture (IF) can show increased uptake on a bone scan (BS). IFs are often misinterpreted as bone metastases if the characteristic “Honda sign” (H-sign) is invisible. The purpose of the present study was to evaluate the utility of magnetic resonance imaging (MRI) alone for the characterization of IF and bone metastasis after radiotherapy in patients with cervical cancer detected by BS. Materials and Methods: Our study included 40 patients with cervical cancer after radiotherapy that showed pelvic emerging increased uptake on a BS during follow-up. Then further MRI examination was performed in all patients. Two radiologists independently reviewed the MR images, and the sensitivity, specificity and accuracy were calculated based on the mean scores. Diagnostic validity of the inter-observer was calculated by using kappa statistics. The gold standard was based on radiologic findings, clinical data and follow-up at least 12 months. Results: A total of 57 emerging bone lesions detected at BS were identified in the reference standard, including 43 IFs and 14 bone metastases. Only 20 patients showed a “H-sign” on the BS images. Using MRI analysis, all lesions detected by BS were found in MRI by both radiologists. On average, the sensitivity, specificity, and accuracy for distinguishing IFs from bone metastases were 95.3% (41/43), 92.8% (13/14), and 94.7% (54/57), respectively. The inter-observer variability was determined to be very good (kappa value = 0.962). Conclusions: MRI is a reliable diagnostic technique for the further characterization of emerging lesions detected by BS, MRI shows great diagnostic efficiency in the differentiation of IF and bone metastasis.

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Section: Introductionmentioning

confidence: 99%

Characterization of Insufficiency Fracture and Bone Metastasis After Radiotherapy in Patients With Cervical Cancer Detected by Bone Scan: Role of Magnetic Resonance Imaging

Zhong

Zhang

et al. 2019

Front. Oncol.

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“…Moreover, this technique can help in identifying the accompanying fractures. SPECT/CT directly correlates bone scintigraphy findings with anatomical structures via three-dimensional reconstructions [ 30 ]. Additionally, SIFs are not a single-episode phenomenon, instead it manifests as an ongoing process of collapse.…”

Section: Discussionmentioning

confidence: 99%

Analysis of Fracture Patterns and Characteristics in Sacral Insufficiency Fracture: Do Sacral Fractures Occur in Patients Who Had Previous Lumbosacral Fusion Insufficiency Fractures or Stress Fractures?

Seo

Kim

et al. 2021

Asian Spine J

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This study is a retrospective analysis of a case. Purpose: The purpose of this study is to investigate the fracture patterns and risk factors of sacral insufficiency fractures (SIFs) to improve their diagnosis in clinical practice.Overview of Literature: SIFs occur when normal stresses are applied to a bone with decreased density, most often due to osteoporosis. Individuals who receive lumbosacral fusion procedures may also suffer from increased incidents of SIFs because of decreased bone density related to aging.Methods: In total, 55 patients with SIFs were retrospectively investigated in this study. The study population was divided into lumbosacral fusion (n=20) and non-fusion (n=35) groups. Subsequently, the patients' demographic characteristics, comorbidities, medication history, results of diagnostic imaging studies, and bone mineral density were assessed. The fracture patterns were classified either according to the five typical types (H-pattern bilateral vertical plus horizontal component, unilateral vertical only, bilateral vertical only, unilateral vertical plus horizontal component, and horizontal only fracture) or atypical types.Results: In total, 44 of 55 patients (80%) suffered from more than one senile disease and received corresponding medications that caused secondary osteoporosis. A total of 12 patients had S1 lumbosacral fixation. Moreover, three of these 12 patients who developed a SIF immediately after a lumbosacral fracture had an unstable sacral U fracture. The remaining nine patients showed fracture patterns similar to the non-fusion patients. Single-photon emission computed tomography (SPECT)/computed tomography (CT) can identify fracture recurrence in previously healed fractures. In total, 24 patients (43.6%) had fractures of the pelvis, femur, and thoracolumbar spine.Conclusions: SIF develops in elderly patients with multiple adult diseases that can induce secondary osteoporosis. Such fractures may occur in the patients with instrumented lumbosacral fusion. Importantly, some patients showed stress fractures after multilevel instrumented lumbosacral fusion, whereas others showed insufficiency fractures. The different fracture patterns correspond to different grades of SIF, and SPECT/CT can easily identify the fracture status.

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“…Whole-body bone scintigraphy (WBS) is a sensitive examination method for the detection of SIF and it is often possible to see a typical characteristic “H” mark that is visible when fracture lines are in the lateral sides and central part of the sacrum. According to some studies, this sign is detected in 30%–40% of SIF cases [ 13 , 14 ]. When the typical “H” sign is not visible or when the patient has a history of oncological disease, these changes are less specific [15] .…”

Section: Discussionmentioning

confidence: 99%

Diagnosing sacral insufficiency fractures after radiotherapy in women with cervical cancer: Report of three cases

Sabaliauskas

Tiškevičius

2021

Radiology Case Reports

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Introduction Diagnosing sacral insufficiency fractures (SIF) in oncology patients is a challenge to radiologists, and recognition of imaging features is essential in order to avoid misdiagnosis of bone metastases and prevent patients from inaccurate treatment. Clinical cases in order to better understand the essence of this pathology and to make diagnosis easier, we present three clinical cases of SIF in patients with cervical cancer. All patients received radiation therapy (external beam radiation and brachytherapy) and chemotherapy with cisplatin. Patients underwent pelvic MRI, CT, SPECT or SPECT/CT examinations. One patient underwent a FDG-PET/CT examination. Conclusions SPECT/CT should be included in the differential diagnostics when radiological features of pelvic bone pathology on CT or MRI are undetermined or SIF are suspected. SIF must always be considered in oncology patients with pelvic pain, especially in postmenopausal state and after radiation therapy. For patients with osteoporosis, bone density screening and precise review of the most common fracture sites are recommended.

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Use of SPECT/CT with 99mTc-MDP Bone Scintigraphy to Diagnose Sacral Insufficiency Fracture

Abstract: Bone SPECT/CT offers additional information on pelvic insufficiency fractures, especially when there is incomplete formation of the H-sign on planar bone scanning.

Cited by 12 publications

References 4 publications

Characterization of Insufficiency Fracture and Bone Metastasis After Radiotherapy in Patients With Cervical Cancer Detected by Bone Scan: Role of Magnetic Resonance Imaging

Characterization of Insufficiency Fracture and Bone Metastasis After Radiotherapy in Patients With Cervical Cancer Detected by Bone Scan: Role of Magnetic Resonance Imaging

Analysis of Fracture Patterns and Characteristics in Sacral Insufficiency Fracture: Do Sacral Fractures Occur in Patients Who Had Previous Lumbosacral Fusion Insufficiency Fractures or Stress Fractures?

Diagnosing sacral insufficiency fractures after radiotherapy in women with cervical cancer: Report of three cases

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