PMC3385498_01
The F-18 FDG PET-CT (maximum intensity projection image) (a) Anterior and (b) posterior show focal low-grade tracer uptake in right level IV cervical lymph node (nonspecific) blue arrow, and vertical linear FDG uptake medial to bilateral sacroiliac joint and horizontal uptake which connects vertical line (H-shaped/ Butterfly shaped) (black arrow) in the sacral region. Standardized uptake maximum value of sacral uptake based on body surface area was 5.8 gm/ml.
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F1
The FDG-PET scan (Maximum Intensity Projection- Figure 1) showed vertical linear FDG uptake in the medial to bilateral sacroiliac joint and horizontal uptake connecting the vertical lines (H-shaped uptake) in the sacral region.
The (a) axial and (b) coronal Maximum Intensity Projection (MIP) CT images show lucent fracture line (black arrow) with breach in the anterior cortex of right sacral ala. The fracture line is away from the right sacral foramina (white arrow) and medial to the sacroiliac joint (arrowhead).
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F2
The axial and coronal maximum intensity projection (MIP) CT images [Figure 2a and 2b] show lucent fracture line (arrow) with breach in the anterior cortex of right sacral ala.
Nuclear magnetic resonance (NMR) images of sacral spine. Short tau inversion recovery (STIR) weighted (a) axial and (b) coronal images through the sacrum revealed complete diffuse hyperintensity of the right sacral ala (black arrow) suggestive of bone marrow bruise/edema. There is also mild hyperintensity in the soft tissue anterior (white arrow) to the right sacral ala suggestive of changes related to bone injury. Bilateral SI joints (black arrowhead) and bilateral iliac bones (white arrowhead) appear unremarkable. These features were suggestive of sacral insufficiency fracture.
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F3
Short tau inversion recovery (STIR)-weighted axial and coronal images [Figure 3a and 3b] through the sacrum revealed complete diffuse hyperintensity of the right sacral ala suggestive of bone marrow bruise/edema.