Bone complications after pelvic radiation therapy: evaluation with MRI
Gamze Ugurluer1, Tugana Akbas, Taner Arpaci
1Department of Radiation Oncology, Acibadem Adana Hospital, Acibadem University, Adana, Turkey.
Introduction:
The purpose of this study was to assess the incidence, distribution and MRI characteristics of pelvic bone complications after radiation therapy.
Methods:
The medical charts of 345 patients who received pelvic radiation therapy were retrospectively reviewed. A total of 122 patients, 99 women and 23 men, with a mean age of 57 (range 32-87 years) were included in this study. The MR images were retrospectively reviewed by two radiologists.
Results:
Fatty replacement of bone marrow was seen in all patients. Pelvic bone complications and focal red marrow changes were identified in a total of 38 patients (31.1%). Pelvic insufficiency fracture was diagnosed in 17 patients (13.9%, with a total of 64 lesions) and radiation osteitis was diagnosed in 5 patients (4.1%, with a total of 13 lesions). Avascular necrosis of the femoral head was detected in one patient (0.8%). Focal red bone marrow changes were seen in 15 patients (12.3%). The median time from the end of radiotherapy to the diagnosis of pelvic bone complications or changes was 25 months (range 2-45 months). The 1-, 2-, and 3-year cumulative incidences were 22%, 41% and 49%, respectively. The distribution of insufficiency fractures was as follows: sacral ala, sacral body, ilium, acetabulum, pubis and lumbar spinal vertebra. The distribution of radiation osteitis was as follows: sacral ala, ilium and pubis.
Conclusion:
Radiation-induced pelvic bone complications are not uncommon, and knowledge of characteristic imaging patterns is essential in order to rule out bone metastases and to avoid inaccurate or excessive treatment.
Insights
Pelvic bone complications like fractures and osteitis are common after radiation therapy, occurring in 31.1% of patients. Understanding MRI patterns is key to differentiate these from bone metastases.
Area of Science:
- Radiology
- Oncology
- Orthopedics
Background:
- Radiation therapy for pelvic cancers can lead to significant bone complications.
- Assessing the incidence and MRI characteristics of these complications is crucial for patient management.
Purpose of the Study:
- To determine the incidence and distribution of pelvic bone complications following radiation therapy.
- To characterize the MRI findings associated with these complications.
Main Methods:
- Retrospective review of 345 patient charts who underwent pelvic radiation therapy.
- Inclusion of 122 patients (99 women, 23 men; mean age 57) for MR image analysis.
- Independent review of MR images by two radiologists.
Main Results:
- Fatty marrow replacement observed in all patients.
- Pelvic bone complications occurred in 31.1% of patients, including insufficiency fractures (13.9%) and radiation osteitis (4.1%).
- Median time to diagnosis was 25 months; 3-year cumulative incidence reached 49%.
Conclusions:
- Radiation-induced pelvic bone complications are frequent.
- Characteristic MRI patterns are essential for accurate diagnosis and to exclude bone metastases.
- Proper interpretation avoids misdiagnosis and unnecessary treatment escalation.
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