Abstract
We report 2 cases of sacral insufficient fracture detected by FDG-PET/CT. In case 1, a 79-year-old female patient with malignant lymphoma, who had recent lumbago, received FDG-PET/CT examination. Vertical linear FDG uptake medial to bilateral sacro-iliac joint was observed on FDG-PET and a fracture line corresponding to FDG uptake was observed in bone window of CT images. In case 2, an 81-year-old male patient with colon cancer, who also complained of lumbago, received FDG-PET/CT examination. Vertical linear FDG uptake medial to bilateral sacro-iliac joint and horizontal uptake which connects vertical line (H-shaped) was demonstrated and CT also demonstrated a fracture line corresponding to FDG uptake. H-shaped high intensity area corresponding to FDG uptake was observed on T2-weighted image of MRI. On bone scintigraphy, H-shaped uptake was also observed. Like bone scintigraphy, typical H-shaped FDG uptake may be diagnostic in sacral insufficiency fracture. Adding CT information to FDG-PET, that is, assessing SIF with FDG-PET/CT may be useful when atypical findings are observed.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Pentecost RL, Murray RA, Brindley HH. Fatigue, insufficiency, and pathological fractures.JAMA 1964; 187: 1001–1004.
Daivies AM. Stress lesions of bone.Curr Imaging 1990; 2: 209–216.
Kanberoglu K, Kanatarci F, Cebi D, Yilmaz MH, Kurugoglu S, BiliciA, et al. Magnentic resonance imaging in osteo-malacic insufficiency fractures of the pelvis.Clin Radiol 2005; 60: 105–111.
Schneider R, Yacovone J, GhelmanB. Unsuspected sacral fractures: detection by radionuclide bone scanning.AJR 1985; 144: 337–341.
Cooper KL, Bebout JW, Swee RG. Insufficiency fractures of the sacrum.Radiology 1985; 156: 15–20.
DeSmet AA, Neff JR. Pubic and sacral insufficiency fractures: clinical course and radiographic findings.AJR 1985; 145: 601–606.
Larson SM. Cancer or inflammation? A Holy Grail for nuclear medicine.J Nucl Med 1994; 35: 1653–1655.
Fayad LM, Cohade C, Wahl RL, Fishman EK. Sacral fractures: a potential pitfall of FDG positron emission tomographyAJR 2003; 181: 1239–1243.
Ravenel JG, Gordon LL, Pope TL, Reed CE. FDG-PET uptake in occult acute pelvic fracture.Skeletal Radiol 2004; 33:99–101.
Schmitz A, Risse JH, Texor J, Zander D, Biersack HK, SchimittO, et al. FDG-PET findings of vertebral compression fractures in osteoporosis: preliminary results.Osteoporos Int 2002; 13: 755–761.
Kato K, Aoki J, Endo K. Utility of FDG-PET in differential diagnosis of benign and malignant fractures in acute to subacute phase.Ann Nucl Med 2003; 17: 41–46.
Shon IH, Fogelman I. F-18 FDG positron emission tomography and benign fractures.Clin Nucl Med 2003; 28: 171–175.
Zhuang H, Sam JW, Chacko TK, Duarte PS, Hickeson M, FengQ, et al. Rapid normalization of osseous FDG uptake following traumatic or surgical fractures.Eur J Nucl Med Mol Imaging 2003; 30: 1096–1103.
Cotty PH, Fouquer B, Mezeenge C, De Toffol B, Beaulien F, Vala JP, et al. Insufficiency fractures of the sacrum; ten cases and review of the literature.J Neuroradiol 1989; 16: 160–171.
Jones JW. Insufficiency fracture of the sacrum with displacement and neurologic damage; a case report and review of the literature.J Am Geriatr Soc 1991; 39: 280–283.
Fujii M, Abe K, Hayashi K, Kosuda S, Yano F, Watanabe S, et al. Honda sign and variants in patients suspected of having a sacral insufficiency fracture.Clin Nucl Med 2005; 30: 165–169.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Tsuchida, T., Kosaka, N., Sugimoto, K. et al. Sacral insufficiency fracture detected by FDG-PET/CT: Report of 2 cases. Ann Nucl Med 20, 445–448 (2006). https://doi.org/10.1007/BF03027382
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF03027382