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

OBJECTIVE: 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. - MATERIAL AND METHODS: 410 patients with pelvic malignancies treated with radiotherapy were re...

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Main Authors: Meixel, Adrian J. (Author) , Hauswald, Henrik (Author) , Delorme, Stefan (Author) , Jobke, Björn (Author)
Format: Article (Journal)
Language:English
Published: 23 February 2018
In: European radiology
Year: 2018, Volume: 28, Issue: 8, Pages: 3550-3559
ISSN:1432-1084
DOI:10.1007/s00330-018-5325-2
Online Access:Verlag, lizenzpflichtig, Volltext: https://doi.org/10.1007/s00330-018-5325-2
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Author Notes:Adrian J. Meixel, Henrik Hauswald, Stefan Delorme, Björn Jobke

MARC

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245 1 0 |a From radiation osteitis to osteoradionecrosis  |b incidence and MR morphology of radiation-induced sacral pathologies following pelvic radiotherapy  |c Adrian J. Meixel, Henrik Hauswald, Stefan Delorme, Björn Jobke 
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520 |a OBJECTIVE: 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. - MATERIAL AND METHODS: 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. - RESULTS: 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. - CONCLUSION: Radiation-induced bone marrow changes appear with a high incidence at the sacrum with an early onset and frequent recovery. The majority presented a pattern of radiation osteitis, whereas osteoradionecrosis was proportionately rare. - KEY POINTS: • Radiation-induced sacral bone marrow changes appear frequently (17.6 %) following pelvic radiotherapy. • Insufficiency fractures are common late effects (43 %). • Radiation osteitis develops early (4 mo), with recovery between 16.5 and 39.5 months. • Definite radiological osteoradionecrosis is proportionately rare (3 %). • A 3-stage classification system simplifies and standardizes the morphological disease staging. 
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650 4 |a Aged 
650 4 |a Aged, 80 and over 
650 4 |a Bone marrow 
650 4 |a Causality 
650 4 |a Comorbidity 
650 4 |a Female 
650 4 |a Follow-Up Studies 
650 4 |a Fractures, Stress 
650 4 |a Humans 
650 4 |a Incidence 
650 4 |a Insufficiency fracture 
650 4 |a Magnetic Resonance Imaging 
650 4 |a Male 
650 4 |a Middle Aged 
650 4 |a Osteitis 
650 4 |a Osteoradionecrosis 
650 4 |a Pelvic Neoplasms 
650 4 |a Pelvis 
650 4 |a Radiation 
650 4 |a Radiation Injuries 
650 4 |a Radiography 
650 4 |a Retrospective Studies 
650 4 |a Risk Factors 
650 4 |a Sacrum 
650 4 |a Time Factors 
650 4 |a Young Adult 
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