Imaging findings of pregnancy-related sacral fractures are similar to sacral insufficiency fractures related to involutional osteoporosis, with the exception that patients will be in their reproductive years and in the last trimester of pregnancy or recently postpartum [56,57]. Bone Scan Whole Body with SPECT or SPECT/CT Area of Interest Bone scintigraphy and CT are both associated with radiation exposure to the fetus in a pregnant patient. For reference, the approximate mean fetal absorbed dose from a pelvis radiograph is 1.1 mGy, from a pelvis CT is 25 mGy, and from a bone scintigraphy is 4.6 mGy (early in pregnancy) and 1.8 mGy (at 9 months estimated gestational age) [62]. Because bone scintigraphy is often nonspecific and supplemental imaging is frequently required, there is consensus in the literature that cross-sectional imaging should supersede bone scintigraphy as the imaging of choice for suspected insufficiency fracture when the radiograph is negative, regardless of the risks of radiation exposure [31]. CT Area of Interest With IV Contrast There is no relevant literature to support the use of CT area of interest with IV contrast because it does not provide added information over noncontrast imaging with regard to stress injury. CT Area of Interest Without and With IV Contrast There is no relevant literature to support the use of CT area of interest without and with IV contrast because it does not provide added information over noncontrast imaging with regard to stress injury. CT Area of Interest Without IV Contrast CT and bone scintigraphy are both associated with radiation exposure to the fetus in a pregnant patient [62]. Therefore, MRI is preferred. MRI Area of Interest Without and With IV Contrast There is no relevant literature to support the use of MRI area of interest without and with IV contrast because it does not provide added information over noncontrast imaging with regard to stress injury.
Stress Fatigue Insufficiency Fracture Including Sacrum Excluding Other Vertebrae PCAs. Imaging findings of pregnancy-related sacral fractures are similar to sacral insufficiency fractures related to involutional osteoporosis, with the exception that patients will be in their reproductive years and in the last trimester of pregnancy or recently postpartum [56,57]. Bone Scan Whole Body with SPECT or SPECT/CT Area of Interest Bone scintigraphy and CT are both associated with radiation exposure to the fetus in a pregnant patient. For reference, the approximate mean fetal absorbed dose from a pelvis radiograph is 1.1 mGy, from a pelvis CT is 25 mGy, and from a bone scintigraphy is 4.6 mGy (early in pregnancy) and 1.8 mGy (at 9 months estimated gestational age) [62]. Because bone scintigraphy is often nonspecific and supplemental imaging is frequently required, there is consensus in the literature that cross-sectional imaging should supersede bone scintigraphy as the imaging of choice for suspected insufficiency fracture when the radiograph is negative, regardless of the risks of radiation exposure [31]. CT Area of Interest With IV Contrast There is no relevant literature to support the use of CT area of interest with IV contrast because it does not provide added information over noncontrast imaging with regard to stress injury. CT Area of Interest Without and With IV Contrast There is no relevant literature to support the use of CT area of interest without and with IV contrast because it does not provide added information over noncontrast imaging with regard to stress injury. CT Area of Interest Without IV Contrast CT and bone scintigraphy are both associated with radiation exposure to the fetus in a pregnant patient [62]. Therefore, MRI is preferred. MRI Area of Interest Without and With IV Contrast There is no relevant literature to support the use of MRI area of interest without and with IV contrast because it does not provide added information over noncontrast imaging with regard to stress injury.