Imaging differentiation of pathologic fractures caused by primary and secondary bone tumors

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• 作者：Theodoros Soldatos^a ; ¹ ; ^{tsoldat1@jhmi.edu} ; Majid Chalian^a ; ¹ ; ^{mchalia1@jhmi.edu} ; Samer Attar^b ; ¹ ; ^{sattar1@jhmi.edu} ; Edward F. McCarthy^c ; ¹ ; ^{emccart2@jhmi.edu} ; John A. Carrino^a ; ¹ ; ^{jcarrin2@jhmi.edu} ; Laura M. Fayad^a ; ^{lfayad1@jhmi.edu}
• 关键词：Pathologic fracture ; Computed tomography ; Bone tumor
• 刊名：European Journal of Radiology
• 出版年：2013
• 出版时间：January, 2013
• 年：2013
• 卷：82
• 期：1
• 页码：e36-e42
• 全文大小：511 K

文摘

class=""h4"">Objective

To describe pre-treatment imaging features of pathologic fractures caused by primary bone tumors (PBTs) and metastatic bone tumors (MBTs) and determine if radiographic or cross-sectional features can differentiate the underlying pathologies associated with the fractures.

class=""h4"">Methods

Sixty-nine patients with a diagnosis of a pathologic fracture were enrolled. Biopsy established PBT as the cause of the pathologic fracture in 16 (23 % ) cases and MBT in 53 (77 % ) cases. The radiographs, computed tomography (CT) scans, and magnetic resonance imaging (MRI) scans of the subjects were retrospectively reviewed for the presence of multiple imaging features.

class=""h4"">Results

Compared to pathologic fractures caused by MBTs, the fractures caused by PBTs demonstrated a higher incidence of lytic bone cortex, mineralization and a soft-tissue mass on radiographs, mineralization and a soft-tissue mass on CT scans, and periosteal abnormality on MRI scans (P < 0.01). These features also exhibited a high negative predictive value in supporting the diagnosis of an underlying PBT over MBT.

class=""h4"">Conclusion

Pathologic fractures caused by PBT and MBT may be differentiated by a few specific radiographic and CT imaging features, though MRI was poor for characterization of the underlying lesion. Such knowledge may assist radiologists in raising the possibility of a PBT as the cause of a pathologic fracture.