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Figure 4. A 76-year-old female with recent onset of increasingly severe low back pain and a history of surgery and radiotherapy for endometrial carcinoma underwent a routine lumbar spine MR examination. (a) Sagittal T2 weighted images through right and left sacral alae showing abnormal high signal at multiple sacral levels (arrows). Slight low signal was seen in these areas on the corresponding T1 weighted images (not shown). (b) Coronal oblique T1 weighted image through sacrum showing low signal in the left sacral ala (open arrows) with a central linear signal defect crossing the sacral body to the right ala (black arrows). There is also minor low signal seen in the right ala (small arrows). (c) Coronal oblique fast spin echo fat suppressed T2 weighted image through sacrum demonstrates a low signal fracture line in the left sacral ala and across the body of the sacrum surrounded by oedema (white arrows). There is also oedema seen within the right ala (black arrow). (d) Posterior view of isotope bone scan shows uptake in the sacral ala (arrowheads) and sacral body (arrows), with an asymmetric H-shaped pattern. (e) CT study confirms bilateral sacral insufficiency fractures (arrows) and shows no destructive mass lesion.
