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. 2023 Sep;34(9):1549-1559.
doi: 10.1007/s00198-023-06812-9. Epub 2023 Jun 7.

Imaging of pelvic ring fractures in older adults and its clinical implications-a systematic review

Anna H M Mennen  1   2 , Alida S Blokland  3 , Mario Maas  4   5 , Daphne van Embden  3   4
Affiliations

Imaging of pelvic ring fractures in older adults and its clinical implications-a systematic review

Anna H M Mennen et al. Osteoporos Int. 2023 Sep.

Abstract

Identifying the full scope of pelvic fracture patterns in older adults has gained clinical importance since the last decennium. CT is recommended as the golden standard; however, MRI has even greater diagnostic accuracy. Dual energy computed tomography (DECT) is a new and promising imaging technique, but the diagnostic accuracy in the context of pelvic fragility fractures (FFPs) has not been widely established. The aim was to provide insight into the diagnostic accuracy of different imaging techniques and the relevance for clinical practice. A systematic search was performed in the PubMed database. All studies that reported on CT, MRI or DECT imaging techniques in older adults who suffered a pelvic fracture were reviewed and, if relevant, included. Eight articles were included. In up to 54% of the patients, additional fractures were found on MRI compared to CT, and in up to 57% of the patients on DECT. The sensitivity of DECT for posterior pelvic fracture detection was similar to MRI. All patients without fractures on CT appeared to have posterior fractures on MRI. After additional MRI, 40% of the patients had a change of classification. DECT and MRI showed very similar results in terms of diagnostic accuracy. Over a third of all patients appear to have a more severe fracture classification after MRI, the majority changing to Rommens type 4. However, in only a few patients who changed of fracture classification, a change of therapy was advised. This review suggests that MRI and DECT scans are superior in diagnosing FFPs.

Keywords: Computed tomography; Dual energy computed tomography; Magnetic resonance imaging; Older adults; Pelvic fragility fracture; Pelvic ring fractures.

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Conflict of interest statement

AHM Mennen received the Amsterdam UMC Doctoral School PhD Scholarship. AS Blokland, M Maas and D van Embden declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
PRISMA 2020 flow diagram for systematic reviews [36]
Fig. 2
Fig. 2
Rommens and Hofmann classification [22]
Fig. 3
Fig. 3
How does the Rommens classification on conventional CT change after additional MRI
Fig. 4
Fig. 4
How does the Rommens classification on conventional CT change after additional DECT
See this image and copyright information in PMC

Comment in

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