From radiation osteitis to osteoradionecrosis: incidence and MR morphology of radiation-induced sacral pathologies following pelvic radiotherapy

European Radiology
Adrian J MeixelBjörn Jobke

Abstract

To investigate the incidence rate, time-to-onset and recovery, MRI morphology and occurrence of insufficiency fractures in radiation-induced changes in the sacrum following pelvic radiotherapy. 410 patients with pelvic malignancies treated with radiotherapy were reviewed. Follow-up was 1-124 months (mean 22 months). Serial MRI (average four studies/patient) were analysed using a new semi-quantitative score (Radiation-Induced Sacral Changes=RISC). A size category (I/II/III), a type category for MR signal morphologies (a/b/c) and sacral insufficiency fractures (+/-) were applied. Seventy-two patients (17.6 %) were found to have new pathological signal changes. Radiation osteitis was documented in 83.3 % (60/72, RISC stage a + b), and definite osteonecrosis (stage c) in 12 patients (16.7 %, 12/72). Thirty-one patients (43.1 %) had sacral insufficiency fractures. Initial bone marrow signal changes were found 1-35 months (median 4 months) after radiotherapy. The maximum manifestation of radiation-induced signal changes occurred after 1-35 months (mean 11 months). Fifty-six cases (77.8 %) showed a significant signal recovery within 16.5 months. Radiation-induced bone marrow changes appear with a high incidence at the sacrum with an e...Continue Reading

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Citations

Jan 31, 2019·Acta Oncologica·Riitta NiinimäkiTuukka Niinimäki
Jul 23, 2020·The Journal of the American Academy of Orthopaedic Surgeons·Rosanna WustrackCarol D Morris
Aug 10, 2020·The Journal of the American Academy of Orthopaedic Surgeons·Rosanna WustrackCarol D Morris
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