Pelvic insufficiency fractures in locally advanced cervical cancer: the diagnostic yield of post-treatment MRI in a tertiary centre

IF 3.2 3区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

European Journal of Radiology Pub Date : 2025-02-01 DOI:10.1016/j.ejrad.2025.111918

Consolato Gullì , Luca Russo , Diana Gavrila , Matteo Mangialardi , Giorgio Mazzotta , Matteo Mancino , Rosa Autorino , Evis Sala , Antonio Leone , Benedetta Gui

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引用次数: 0

Abstract

Purpose

To assess the incidence of pelvic insufficiency fractures (PIFs) after concurrent chemoradiotherapy (CCRT) in patients with locally advanced cervical cancer (LACC), their time of onset and risk factors. We also analysed the inter-observer agreement between gynaecologic radiologists (GYN readers) and radiologists expert in musculoskeletal imaging (MSK reader) in detecting PIFs in our tertiary care centre.

Methods

Patients with confirmed LACC who underwent concurrent chemoradiation (CCRT) at our institution from June 2019 to November 2022 were retrospectively included. These patients underwent follow-up pelvic MRI every 3–6 months after CCRT. Cohen’s kappa statistics was employed to assess the inter-observer agreement between GYN and MSK readers. Logistic regression analysis was performed calculating odds ratios (OR) to identify risk factors for PIFs, such as age, body mass index (BMI), diabetes, smoking, hypertension, renal function and tumour size.

Results

Eighty-seven patients were included. PIFs were diagnosed in 21/87 (24.1 %) patients with a median onset time of 7.4 months from the end of EBRT. Among risk factors, age was statistically associated with PIFs (OR = 1.057, 95 % CI: 1.005–1.118, p = 0.033) with median age in the fracture group of 61.1 years (range: 52.0–71.5) and 53.8 years (range: 43.8–63.3). BMI was a significant predictor of PIFs (OR = 1.134; 95 % CI: 1.013–1.285; p = 0.027), with a higher median BMI among patients with PIFs (26.5; range: 21.5–31.2) compared to non-fractured patients (23.1; range: 20.2–25.1). Also patients with reduced renal function (eGFR < 60 mL/min) had 3.437 times higher odds of experiencing fractures compared to those with normal eGFR. The GYN readers correctly identified PIFs in 2/21 cases and agreed with the MSK reader in 68/87 cases. The interobserver agreement was poor to fair (K = 0.138; 95 % CI: 0–0.311).

Conclusions

PIFs are a common complication of CCRT. Their identification on post-CCRT MRI may decrease the need for further targeted investigations and invasive treatments.

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局部晚期宫颈癌盆腔功能不全骨折：三级中心治疗后MRI的诊断率。

目的：探讨局部晚期宫颈癌（LACC）患者同步放化疗（CCRT）后盆腔功能不全骨折（pif）的发生率、发病时间及危险因素。我们还分析了在我们的三级保健中心检测pif时，妇科放射科医生（GYN阅读器）和肌肉骨骼成像放射科专家（MSK阅读器）之间的观察者间协议。方法：回顾性纳入2019年6月至2022年11月在我院接受同步放化疗（CCRT）的确诊LACC患者。这些患者在CCRT后每3-6个月随访一次盆腔MRI。采用Cohen's kappa统计来评估GYN和MSK读者之间的观察者间一致性。进行Logistic回归分析，计算比值比（OR），以确定pif的危险因素，如年龄、体重指数（BMI）、糖尿病、吸烟、高血压、肾功能和肿瘤大小。结果：纳入87例患者。87例患者中有21例（24.1%）被诊断为pif，中位发病时间为EBRT结束后7.4个月。危险因素中，年龄与pif有统计学相关性（OR = 1.057, 95% CI: 1.005 ~ 1.118, p = 0.033），骨折组中位年龄分别为61.1岁（52.0 ~ 71.5）和53.8岁（43.8 ~ 63.3）。BMI是pif的显著预测因子(OR = 1.134；95% ci: 1.013-1.285；p = 0.027)， pif患者的中位BMI较高(26.5；范围：21.5-31.2)与非骨折患者(23.1；范围:20.2 - -25.1)。结论：pif是CCRT的常见并发症。在ccrt后MRI上对其进行识别可能会减少进一步有针对性的调查和侵入性治疗的需要。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

European Journal of Radiology 医学-核医学

CiteScore

6.70

自引率

3.00%

发文量

398

审稿时长

42 days

期刊介绍： European Journal of Radiology is an international journal which aims to communicate to its readers, state-of-the-art information on imaging developments in the form of high quality original research articles and timely reviews on current developments in the field. Its audience includes clinicians at all levels of training including radiology trainees, newly qualified imaging specialists and the experienced radiologist. Its aim is to inform efficient, appropriate and evidence-based imaging practice to the benefit of patients worldwide.