Optimized Pelvic Imaging in Traumatology of the Elderly: Methods, Clinical Impact, and What We Can Achieve

Introduction Fragility fractures of the pelvis (FFPs) are increasing because of the aging demographic. However, this type of fracture is sometimes difficult to diagnose, and often treatment is delayed. Imaging of the conservatively/operatively treated patient can also cause difficulties because standard radiographic techniques are inadequate.

Material and Methods A summary of the results of our working group of the past 2 years highlights the value of magnetic resonance imaging (MRI), computed tomography (CT), and dual-energy computed tomography (DECT) for the diagnosis of FFPs and its direct influence on patient management. Clinical impact and the comparison of radiation exposure were also investigated.

Results Bone marrow edema is the key to the diagnosis of an FFP. MRI and DECT perform perfectly here and are regarded as the gold standard (CT scans in ~ 30% of patients are false negatives). The improved diagnosis with MRI/DECT aids fracture classification and thus the clinical care of patients.

Low-dose CT is able to produce good image quality at < 1 mSv per scan and therefore within the range of a radiographic examination in three planes. Due to the improved imaging of the posterior pelvic ring, CT is clearly superior to radiographs for clinical evaluation.

Conclusion The early use of MRI or DECT leads to a significant improvement in the diagnosis of FFPs and has a direct influence on patient management. The use of low-dose CT instead of radiographs for follow-up also provides a benefit for further patient treatment with similar dose exposure.