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      Multimodality imaging evaluation for iliac crest apophysis avulsion injury

      case-report
      , MD a , , MD b , , MD c , , MD c , , MD, PhD a , *
      Radiology Case Reports
      Elsevier
      Iliac crest apophysis injury, Bone scan

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          Abstract

          A young cross-country athlete with left thigh pain, and a recent negative MRI of the left hip was referred to nuclear medicine for bone scan imaging. A 3-phase Tc-99m methylene diphosphonate bone scan was performed and revealed left iliac crest apophysis avulsion. This case illustrates that 3-phase bone scan is a great adjunct in the evaluation of sports injuries especially in athletes presenting with vague nonlocalizing symptoms, and prior negative radiographic or MRI imaging.

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          Most cited references7

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          Imaging features of avulsion injuries.

          Avulsion injuries are common among participants in organized sports, especially among adolescent participants. Imaging features of both acute and chronic avulsion injuries of the pelvis, knee, ankle and foot, shoulder, and elbow were evaluated to help distinguish these injuries from more serious disease processes such as neoplasm and infection. At radiography, acute injuries (ie, those resulting from extreme, unbalanced, often eccentric muscular contractions) may be associated with avulsed bone fragments, whereas subacute injuries have an aggressive appearance that may include areas of mixed lysis and sclerosis. Chronic injuries (ie, those resulting from repetitive microtrauma or overuse) or old inactive injuries may be associated with a protuberant mass of bone and may bear a striking resemblance to a neoplastic or infectious process. Although not usually required, computed tomography is helpful in the diagnosis if radiographic findings are equivocal or if the injury is not in the acute phase. MR imaging is best suited for the evaluation of injuries to muscles, tendons, and ligaments. Recognition of characteristic imaging features and familiarity with musculotendinous anatomy will aid in accurate diagnosis of avulsion injuries.
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            Avulsion injuries of the pelvis.

            Pelvic avulsion injuries occur in both the skeletally immature and adult patient populations. Avulsion injuries are most common in the adolescent age group and usually present as an avulsion of the unfused apophysis at the level of tendon attachment resulting from violent muscular contraction during an athletic endeavor. Acute apophyseal avulsion injuries are usually easily detected and adequately imaged with radiographs, but occasionally advanced imaging such as magnetic resonance imaging or computed tomography is required to detect and fully delineate the extent of injury. Chronic injuries can mimic a more aggressive lesion, but familiarity with the location of various tendon attachment sites on the osseous pelvis can help avoid this pitfall. Traumatic avulsion injuries can also occur in the skeletally mature pelvis; however, in the adult, the presence of a pelvic avulsion fracture in the absence of trauma should be considered a pathological lesion until proven otherwise. This article discusses the clinical and imaging findings of apophyseal avulsion injuries in the adolescent athlete, followed by a discussion of specific pelvis avulsion injuries that occur in the adult population.
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              Clinical value of combined single photon emission computerized tomography and conventional computer tomography (SPECT/CT) in sports medicine.

              Integrated hybrid single photon emission computerized tomography (SPECT)/computer tomography (CT) is a promising new diagnostic imaging modality for orthopedic patients. A high diagnostic yield is available from combining the detection of abnormal bone metabolism with SPECT, to the precise anatomical detail available in high resolution CT. With this review, we endeavor to illustrate the clinical value and future perspectives of SPECT/CT in sports medicine.
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                Author and article information

                Contributors
                Journal
                Radiol Case Rep
                Radiol Case Rep
                Radiology Case Reports
                Elsevier
                1930-0433
                06 June 2019
                August 2019
                06 June 2019
                : 14
                : 8
                : 986-988
                Affiliations
                [a ]Department of Radiology, University of New Mexico, 1 University of New Mexico, MSC 10-5530, Albuquerque, NM 87131, USA
                [b ]Department of Radiology, College of Medicine, University of Florida, Gainesville, FL, USA
                [c ]Department of Nuclear Medicine, University of Washington, Seattle, WA, USA
                Author notes
                [* ]Corresponding author. elojeim@ 123456gmail.com
                Article
                S1930-0433(19)30193-1
                10.1016/j.radcr.2019.05.016
                6556494
                1df418bb-fc32-4e18-9d31-3495a06b5e05
                © 2019 The Authors

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                : 15 April 2019
                : 12 May 2019
                : 12 May 2019
                Categories
                Nuclear Medicine

                iliac crest apophysis injury,bone scan
                iliac crest apophysis injury, bone scan

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