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Sacral Fractures: A Potential Pitfall of FDG Positron Emission Tomography

Laura M. Fayad1, Christian Cohade, Richard L. Wahl and Elliot K. Fishman

1 All authors: The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, 601 N Wolfe St., Baltimore, MD 21287-0705.



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  		Fig. 1A. —65-year-old woman with history of adenocarcinoma of cecum who underwent right hemicolectomy with adjuvant chemotherapy and radiation. Maximum-intensity-projection positron emission tomography (PET) scan of whole body shows moderate diffuse FDG uptake in left sacrum (arrow).

 


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  		Fig. 1B. —65-year-old woman with history of adenocarcinoma of cecum who underwent right hemicolectomy with adjuvant chemotherapy and radiation. Axial PET scan shows moderate diffuse FDG uptake in left sacrum (arrow).

 


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  		Fig. 1C. —65-year-old woman with history of adenocarcinoma of cecum who underwent right hemicolectomy with adjuvant chemotherapy and radiation. Axial CT scan shows left sacral fracture (arrow).

 


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  		Fig. 2A. —73-year-old woman with history of adenocarcinoma of rectum who underwent abdominal perineal resection with adjuvant chemotherapy and radiation treatment. Axial positron emission tomography scan shows moderate linear FDG uptake in sacrum bilaterally (arrows).

 


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  		Fig. 2B. —73-year-old woman with history of adenocarcinoma of rectum who underwent abdominal perineal resection with adjuvant chemotherapy and radiation treatment. Axial CT scans show vertical (B) and horizontal (C) sacral fractures (arrows).

 


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  		Fig. 2C. —73-year-old woman with history of adenocarcinoma of rectum who underwent abdominal perineal resection with adjuvant chemotherapy and radiation treatment. Axial CT scans show vertical (B) and horizontal (C) sacral fractures (arrows).

 


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  		Fig. 3A. —67-year-old woman with history of adenocarcinoma of rectum who underwent low anterior resection with adjuvant chemotherapy and radiation. Maximum-intensity-projection positron emission tomography (PET) scan of whole body shows moderate diffuse FDG uptake in right sacrum (arrow).

 


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  		Fig. 3B. —67-year-old woman with history of adenocarcinoma of rectum who underwent low anterior resection with adjuvant chemotherapy and radiation. Axial PET scan again shows moderate diffuse FDG uptake predominantly in right sacrum (arrow).

 


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  		Fig. 3C. —67-year-old woman with history of adenocarcinoma of rectum who underwent low anterior resection with adjuvant chemotherapy and radiation. Axial T2-weighted fast spin-echo image (TR/TE, 5,000/77) shows bilateral linear signal abnormalities representing sacral fractures (arrows).

 


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  		Fig. 3D. —67-year-old woman with history of adenocarcinoma of rectum who underwent low anterior resection with adjuvant chemotherapy and radiation. Coronal fat-suppressed T2-weighted fast spin-echo image (3,400/77) shows bilateral linear signal abnormalities representing sacral fractures (arrows), surrounded by bone marrow edema.

 


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  		Fig. 3E. —67-year-old woman with history of adenocarcinoma of rectum who underwent low anterior resection with adjuvant chemotherapy and radiation. Axial T1-weighted spin-echo image (600/9) shows bilateral bandlike decreased signal in sacrum (arrows).

 

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