MRI and CT of

Insufficiency Fractures of the
Pelvis and the Proximal Femur

AJR 2008;191:995-1001
R4 이진영

radiation therapy to the pelvis. pubic ramus • Insufficiency fracture – Normal stress applied to Abnormal bone – Risk factors : Osteoporosis (most often afflicting elderly women). calcaneus. tibial shaft. RA . chronic steroid use. Stress fracture • Fatigue fracture – Normal bone is subjected to repetitive stresses – Common site : Metatarsal. femoral neck.

Purpose • To compare the sensitivity of CT and MRI in detecting insufficiency fractures. morphology. to analyze the typical location. and combinations thereof in these fractures. .

104 women. imaging findings. cross- sectional f/u studies consistent with the diagnosis of an insufficiency fracture. sacral.9 ± 17. other bone marrow disease. . average age.7 years) . 65.absence of metastatic disease to pelvic bones. metabolic disease • 307 fractures in 145 consecutive patients ( 41 men. or proximal femur insufficiency fractures • Pts who had clinical history.terials and Methods Subjects • January 1997~ June 2007 • MRI and CT studies with a reported diagnosis of pelvic.

FOV : 32-36cm • Lumbar spine including sacrum in 20 pts sagittal and axial T1-wieghted (TR/TE : 500-600msec/minimum) fat-saturated T2-weighted fast spin-echo (TR/TE : 3500-4000msec/60-90) coronal T1-weighted fast spin-echo (500msec/minimum) section thickness : 4mm. FOV : 16-24cm . inversion time. GE Healthcare) • All 145 subjects • Pelvis MRI in 125 pts coronal T1-wieghted fast spin-echo (TR/TE : 600msec/minimum) coronal T1-wieghted STIR (3000/68. matrix size : 192x192 mm.terials and Methods MRI • 1.5 T (Signa. 150msec) axial T1-weighted (600msec/minimum) fat-saturated T2-weighted fast spin-echo (3000/68) section thickness : 4mm. matrix size : 256x192 mm.

150-300mA .25-7mm. 125 kVp.terials and Methods CT • MDCT – 8-. GE Healthcare) • 64/145 subjects • Entire pelvis slice thickness : 1. 16-. 64-MDCT (Lightspeed series.

imaging follow up . imaging datas.terials and Methods Image Analysis • Two radiologists. by consensus • Analyze MRI and CT separately in random order • Standard of reference – clinical history.

presence.fracture lines .presence of soft tissue lesions • MRI : presence of BM edema pattern CT: focal sclerotic areas. number and location of fracture .terials and Methods Image Analysis • CT and MRI . adjacent radiolucency .

esults Fracture Locations and Numbers in All 145 Subjects .

98%.01) . 129 fractures • MRI : 128 fractures in 63 pts (sensitivity.esults CT Versus MRI • Detection of pelvic insufficiency fractures • Among 64 pts. 89/129) MRI > CT (p < 0. 53%. 128/129) CT: 89 fractures in 34 pts (sensitivity.

esults CT Versus MRI  Fracture detection rates and locations .

history of esophageal cancer. chemotherapy.esults M/53. osteoporotic BMD on DXA .

5%. MRI>CT). CT>MRI) • Detection of fracture lines – 122/128 on MRI (95.esults CT Versus MRI • Depiction of fracture morphology – 32/88 (36.7%) • Detection of soft tissue abnormalities – 103 lesions in 57 of 64 pts – 102/103 on MRI (99%).6%) .4%. 26/88 (29. 13/103 on CT (12.3%). 78/89 on CT (89.

3%) .esults Overall characteristics  More than one fracture in 102 of 145 pts (70.

esults M/18 with ulcerative colitis and primary sclerosing cholangitis FST2 .

2%) cases. BM edmea with fracture line 21/307 cases (6.only fracture lines 19/307 (6.esults Overall characteristics on MRI • Presence of BM edema pattern and fracture lines 267/307 (87%). only BM edema • Soft tissue abnormalities – Common in femoral. acetabular.8%).4%) Rheumatologic disease : 6/145(4. pubic fractures – Less in sacral fractures Associated clinical finding • Associated with Prior malignancy: 63/145 (34.1%) Corticosteroid tx : 18/145(12.4%) .

and associated clinical features(malignancy) • MRI is superior technique compared with CT and should be imaging technique of choice • Multiple pelvic insufficiency fractures are frequently found (pubic or acetabular) fracture  Careful search for concomitant fractures . their location. morphology. Conclusion • Must be familiar with these findings.