EURORAD ESR

Case 13062

Osteonecrosis of the sacrum following pelvic radiotherapy

Author(s)
Meixel A, Jobke B

University of Heidelberg,
German Research Cancer Center (DKFZ),
Dept. of Radiology;
Im Neuenheimer Feld 280,
69120 Heidelberg, Germany
 
Patient
female, 87 year(s)
 
 
  • Figure 1
    6 weeks after radiotherapy
     

    T1-weighted TSE fs coronal post Gad: no pathology found in the sacral bone

     
    Area of Interest: Pelvis; Imaging Technique: MR; Procedure: Contrast agent-intravenous; Special Focus: Neoplasia;

    T1-weighted VIBE axial: no pathology found

     
    Area of Interest: Pelvis; Imaging Technique: MR; Procedure: Contrast agent-intravenous; Special Focus: Neoplasia;
     
     
  • Figure 2
    8 months after radiotherapy
     

    T1-weighted TSE fs coronal post Gad: slightly increased focal and extensive diffuse signal increase in the left sacrum adjacent to the SIJ, less evident on the right side.

     
    Area of Interest: Pelvis; Imaging Technique: MR; Procedure: Contrast agent-intravenous; Special Focus: Neoplasia;

    T1-weighted VIBE axial: decreased signal intensity within the left massa laterale.

     
    Area of Interest: Pelvis; Imaging Technique: MR; Procedure: Contrast agent-intravenous; Special Focus: Neoplasia;
     
     
  • Figure 3
    12 months after radiotherapy
     

    T1-weighted TSE fs coronal post Gad: diffuse signal increase in the sacrum bilaterally with a centrally decreased signal area on the right side compatible with osteonecrosis.

     
    Area of Interest: Pelvis; Imaging Technique: MR; Procedure: Contrast agent-intravenous; Special Focus: Neoplasia;

    T1-weighted TSE axial post Gad: subtle hypointense line in the left anterior massa laterale parallel to the SIJ, compatible with an insufficiency fracture.

     
    Area of Interest: Pelvis; Imaging Technique: MR; Procedure: Contrast agent-intravenous; Special Focus: Neoplasia;
     
     
  • Figure 4
    40 months after radiotherapy
     

    T1-weighted vibe fs coronal: decreased signal intensity in comparison to previous imaging; circular hyperintense signal in right massa laterale, subtle hyperintense signal in the left massa laterale.

     
    Area of Interest: Pelvis; Imaging Technique: MR; Procedure: Contrast agent-intravenous; Special Focus: Neoplasia;

    T1-weighted vibe fs axial post Gad: enhancement in right massa laterale and small residual focal enhancement in left massa laterale.

     
    Area of Interest: Pelvis; Imaging Technique: MR; Procedure: Contrast agent-intravenous; Special Focus: Neoplasia;
     
     
T1-weighted TSE fs coronal post Gad: no pathology found in the sacral bone
 
T1-weighted VIBE axial: no pathology found
 
T1-weighted TSE fs coronal post Gad: slightly increased focal and extensive diffuse signal increase in the left sacrum adjacent to the SIJ, less evident on the right side.
 
T1-weighted VIBE axial: decreased signal intensity within the left massa laterale.
 
T1-weighted TSE fs coronal post Gad: diffuse signal increase in the sacrum bilaterally with a centrally decreased signal area on the right side compatible with osteonecrosis.
 
T1-weighted TSE axial post Gad: subtle hypointense line in the left anterior massa laterale parallel to the SIJ, compatible with an insufficiency fracture.
 
T1-weighted vibe fs coronal: decreased signal intensity in comparison to previous imaging; circular hyperintense signal in right massa laterale, subtle hyperintense signal in the left massa laterale.
 
T1-weighted vibe fs axial post Gad: enhancement in right massa laterale and small residual focal enhancement in left massa laterale.
 
 
 
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