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Erschienen in: Archives of Orthopaedic and Trauma Surgery 12/2018

30.07.2018 | Orthopaedic Surgery

Is routine MRI necessary to exclude pathological fractures in patients with an oncological history?

verfasst von: Daniel Wei Ren Seng, Ernest Beng Kee Kwek

Erschienen in: Archives of Orthopaedic and Trauma Surgery | Ausgabe 12/2018

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Abstract

Introduction

Magnetic resonance imaging (MRI) is the radiological modality of choice for diagnosing pathological fractures in situations of diagnostic uncertainty. With the increasing availability of MRI, we have observed a disturbing trend in utilising routine MRI scans to exclude pathological fractures in all patients with a history of cancer. The study objective was to determine if routine use of MRI scans in such patients is truly necessary and if other predictive factors can be utilised in lieu of the MRI scan.

Materials and methods

A 3-year retrospective study was conducted reviewing all extremity MRI scans performed for suspected pathological fractures and compared to X-rays. All patients presented with an extremity fracture, a known diagnosis of solid organ cancer and had an MRI to determine if the fracture was pathological. Subjects were followed up with serial X-rays up to 1 year.

Results

84 subjects were recruited. Comparing X-rays alone with MRI scans revealed 92% sensitivity and 98% specificity in detecting pathological fractures. Using X-rays in combination with an absent history of trauma increases the sensitivity to 100% but reduced the specificity to 91%. None of subjects in cancer remission had pathological fractures.

Conclusions

MRI is an imperative tool for operative planning in pathological fractures; however, we recommend against the routine use of MRI to diagnose pathological fractures in oncological patients. Patients with solid organ cancer remission, a positive history of significant trauma prior to sustaining the fracture, and the absence of pathological features on plain radiographs are strongly predictive against pathological fractures.
Literatur
1.
Zurück zum Zitat Heck RKJ (2013) Malignant tumors of bone. In: Canale ST, Beaty JH (eds) Campbell’s operative orthopaedics, 12th edn. Elsevier, Philadelphia Heck RKJ (2013) Malignant tumors of bone. In: Canale ST, Beaty JH (eds) Campbell’s operative orthopaedics, 12th edn. Elsevier, Philadelphia
2.
Zurück zum Zitat Hage WD, Aboulafia AJ, Aboulafia DM (2000) Incidence, location and diagnostic evaluation of metastatic bone disease. Orthop Clin N Am 31:515–528CrossRef Hage WD, Aboulafia AJ, Aboulafia DM (2000) Incidence, location and diagnostic evaluation of metastatic bone disease. Orthop Clin N Am 31:515–528CrossRef
3.
Zurück zum Zitat Clain A (1965) Secondary malignant disease of bone. Br J Cancer 19:15–29CrossRef Clain A (1965) Secondary malignant disease of bone. Br J Cancer 19:15–29CrossRef
4.
Zurück zum Zitat Tsuzuki S, Park SH, Eber MR et al (2016) Skeletal complications in cancer patients with bone metastases. Int J Urol 23:825–832CrossRef Tsuzuki S, Park SH, Eber MR et al (2016) Skeletal complications in cancer patients with bone metastases. Int J Urol 23:825–832CrossRef
5.
Zurück zum Zitat Rybak LD, Rosenthal DI (2001) Radiological imaging for the diagnosis of bone metastases. Q J Nucl Med 45:53–64PubMed Rybak LD, Rosenthal DI (2001) Radiological imaging for the diagnosis of bone metastases. Q J Nucl Med 45:53–64PubMed
6.
Zurück zum Zitat Kattapuram SV, Khurana JS, Scott JA et al (1990) Negative scintigraphy with positive magnetic resonance imaging in bone metastasis. Skelet Radiol 19:113–116CrossRef Kattapuram SV, Khurana JS, Scott JA et al (1990) Negative scintigraphy with positive magnetic resonance imaging in bone metastasis. Skelet Radiol 19:113–116CrossRef
7.
Zurück zum Zitat Fayad LM, Kawamoto S, Ihab R et al (2005) Distinction of long bone stress fractures from pathologic fractures on cross-sectional imaging: how successful are we? Am J Roentgenol 185:915–924CrossRef Fayad LM, Kawamoto S, Ihab R et al (2005) Distinction of long bone stress fractures from pathologic fractures on cross-sectional imaging: how successful are we? Am J Roentgenol 185:915–924CrossRef
8.
Zurück zum Zitat Fayad LM, Kamel IR, Kawamoto S et al (2005) Distinguishing stress fractures from pathological fracture: a multimodality approach. Skelet Radiol 34:245–259CrossRef Fayad LM, Kamel IR, Kawamoto S et al (2005) Distinguishing stress fractures from pathological fracture: a multimodality approach. Skelet Radiol 34:245–259CrossRef
9.
Zurück zum Zitat Hu YC, Lun DX, Wang H (2012) Clinical features of neoplastic pathological fracture in long bones. Chin Med J (Engl) 125(17):3127–3132 Hu YC, Lun DX, Wang H (2012) Clinical features of neoplastic pathological fracture in long bones. Chin Med J (Engl) 125(17):3127–3132
10.
Zurück zum Zitat Buckwalter JA, Brandser EA (1997) Stress and insufficiency fractures. Am Fam Physician 56:175–182PubMed Buckwalter JA, Brandser EA (1997) Stress and insufficiency fractures. Am Fam Physician 56:175–182PubMed
11.
Zurück zum Zitat Toy PC, Heck RKJ (2013) General principles of tumors. In: Canale ST, Beaty JH (eds) Campbell’s operative orthopaedics, 12th edn. Elsevier, Philadelphia Toy PC, Heck RKJ (2013) General principles of tumors. In: Canale ST, Beaty JH (eds) Campbell’s operative orthopaedics, 12th edn. Elsevier, Philadelphia
12.
Zurück zum Zitat Wedin R (2001) Surgical treatment for pathologic fracture. Acta Orthop Scand 72(4):1–29CrossRef Wedin R (2001) Surgical treatment for pathologic fracture. Acta Orthop Scand 72(4):1–29CrossRef
13.
Zurück zum Zitat Hanna SL, Fletcher BD, Fairclough DL, Jenkins JH 3rd, Le AH (1991) Magnetic resonance imaging of disseminated bone marrow disease in patients treated for malignancy. Skelet Radiol 20:79–84CrossRef Hanna SL, Fletcher BD, Fairclough DL, Jenkins JH 3rd, Le AH (1991) Magnetic resonance imaging of disseminated bone marrow disease in patients treated for malignancy. Skelet Radiol 20:79–84CrossRef
Metadaten
Titel
Is routine MRI necessary to exclude pathological fractures in patients with an oncological history?
verfasst von
Daniel Wei Ren Seng
Ernest Beng Kee Kwek
Publikationsdatum
30.07.2018
Verlag
Springer Berlin Heidelberg
Erschienen in
Archives of Orthopaedic and Trauma Surgery / Ausgabe 12/2018
Print ISSN: 0936-8051
Elektronische ISSN: 1434-3916
DOI
https://doi.org/10.1007/s00402-018-3012-z

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