Blomlie V, Rofstad E K, Talle K, Sundfør K, Winderen M, Lien H H
Department of Radiology, the Norwegian Radium Hospital, Montebello, Oslo, Norway.
AJR Am J Roentgenol. 1996 Nov;167(5):1205-10. doi: 10.2214/ajr.167.5.8911181.
The purpose of this study was to assess the incidence, time of appearance, and evolution of radiation-induced insufficiency fractures of the female pelvis with MR imaging.
Eighteen women (nine premenopausal and nine postmenopausal) with advanced cervical carcinoma were studied prospectively with MR imaging. The examinations totaled 216 and were scheduled before radiation therapy, three times during radiation therapy, and eight times after radiation therapy. T1-weighted and short inversion time inversion recovery images were obtained. The images were evaluated by two radiologists in consensus. The criterion for fracture was edema, indicated by an area of high signal intensity on short inversion time inversion recovery images and corresponding low signal intensity on T1-weighted images. CT scans (n = 61) and bone scans (n = 58) were used to confirm each diagnosis of fracture.
Sixteen (89%) of 18 patients (seven premenopausal and nine postmenopausal) showed findings compatible with insufficiency fractures. Thirteen patients had more than one lesion. The first fracture was detected between 3 and 12 months after the end of radiation therapy. During the study, the fractures associated with edema subsided without treatment in 41 (79%) of 52 lesions in 15 (94%) of 16 patients. Fractures were confirmed with additional imaging in all 16 patients (CT in 14 patients and bone scanning in nine patients).
Radiation-induced insufficiency fractures were frequently seen in premenopausal and postmenopausal women within 12 months after radiation therapy. Multiple fractures developed within 24 months. Twenty-one percent of the lesions healed during the observation period of 30 months.
本研究旨在通过磁共振成像（MR成像）评估女性骨盆放射性骨不全骨折的发生率、出现时间及演变情况。
对18例患有晚期宫颈癌的女性（9例绝经前女性和9例绝经后女性）进行前瞻性MR成像研究。检查共计216次，安排在放疗前、放疗期间3次以及放疗后8次进行。获取了T1加权像和短反转时间反转恢复（STIR）像。由两名放射科医生共同评估图像。骨折的标准为水肿，在STIR像上表现为高信号强度区域，在T1加权像上表现为相应的低信号强度。使用计算机断层扫描（CT扫描，n = 61）和骨扫描（n = 58）来确诊每一例骨折。
18例患者中有16例（89%）（7例绝经前女性和9例绝经后女性）显示出与骨不全骨折相符的表现。13例患者有不止一处病变。首次骨折在放疗结束后3至12个月被检测到。在研究期间，16例患者中15例（94%）的52处病变中有41处（79%）与水肿相关的骨折未经治疗即消退。所有16例患者均通过额外的影像学检查确诊骨折（14例患者通过CT检查，9例患者通过骨扫描检查）。
放射性骨不全骨折在绝经前和绝经后女性放疗后12个月内较为常见。24个月内出现多处骨折。在30个月的观察期内，21%的病变愈合。
