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The Sacrum: Pathologic Spectrum, Multimodality Imaging, and Subspecialty Approach¹

¹ From the Department of Radiology, Winthrop University Hospital, 259 First St, Mineola, NY 11501 (J.D., O.O., R.A.L., D.B.P., M.W.H., D.S.K.); the Department of Radiology, State University of New York School of Medicine, Stony Brook (J.D., O.O., R.A.L., D.B.P., M.W.H., D.S.K.); the Department of Radiology, University of Maryland School of Medicine, Baltimore (O.O.); and the Department of Radiology, Yale University School of Medicine, New Haven, Conn (M.W.H.). Presented as a scientific exhibit at the 1999 RSNA scientific assembly. Received March 7, 2000; revision requested April 5 and received May 31; accepted June 1. Address correspondence to D.S.K. (e-mail: dsk2928@pol.net).

The sacrum is a structure that is imaged by both general and subspecialty radiologists. A wide variety of disease processes can involve the sacrum either focally or as part of a systemic process. Plain radiographs, although limited in evaluation of the sacrum, should be carefully examined when abnormalities of the sacrum are suspected. Cross-sectional imaging, particularly computed tomography and magnetic resonance (MR) imaging, plays a crucial role in identification, localization, and characterization of sacral lesions. Congenital lesions of the sacrum, including sacral agenesis and meningocele, are optimally imaged with MR. The most common sacral neoplasm is metastatic disease. Primary neoplasms of the sacrum, which include giant cell tumor, chordoma, and teratoma, are infrequent. Infection of the sacrum or sacroiliac joint is most often due to contiguous spread from a suppurative focus. A wide variety of arthritic disorders such as ankylosing spondylitis and osteoarthritis can involve the sacroiliac joints as part of a localized or systemic process. Sacral fractures related to acute trauma or repetitive stress are difficult to diagnose and treat. Knowledge of these abnormalities and familiarity with the imaging of these processes will allow radiologists of all subspecialties to contribute to the diagnosis and management of sacral disorders.

Index Terms: Sacrum, 33.92 • Sacrum, fractures, 33.41 • Sacrum, neoplasms, 33.30 • Spine, arthritis, 337.70 • Spine, developmental defect, 33.14 • Spine, infection, 33.20

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