Iliac Wing Sign. Sentinel sign for ipsilateral pelvic and hip disorders. Dr Antoine MARCHAND Dr Raphaël GUILLIN
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1 Iliac Wig Sig Setiel sig for ipsilateral pelvic ad hip disorders Dr Atoie MARCHAND Dr Raphaël GUILLIN Departmet of Radiology ad Medical Imagig, CHRU of Rees, FRANCE
2 Cotext Materials ad methods Results Discussio ad coclusio Iliac Wig Sig (IWS)? High Itesity liear image o fatsuppressed T2 sequece O the iterface betwee the deeper aspect of the iliacus muscle ad the iliac boe
3 Cotext Materials ad methods Results Discussio ad coclusio IWS: why idirect radiologic sigs are importat Mme B, 26 years old, suspicio of septic spodylodiscitis MRI of spie : Additioal pelvis MRI :
4 Cotext Materials ad methods Results Discussio ad coclusio Precedet studies But o correlatio betwee IWS ad Age, weight, geder, status No distictio betwee: Uilateral (U-IWS) Bilateral ad Asymmetrical (BA-IWS) Bilateral Symmetrical (B-IWS) Kakigi, Eur J Radiol, 2012 Eshed, Acta Radiol, 2013
5 Cotext Materials ad methods Results Discussio ad coclusio Iliac Wig Sig Study Retrospective study Review of pelvis MRI examiatio realised betwee 2010 ad 2012 Iclusio criteria: at least 1 coroal T2 with FS No hip prosthesis or other orthopaedic device, iitial sacro iliitis suspicio 304 MRI icluded Average Age of patiets : 44 years old (0,5-87) 172 me ad 132 wome
6 Cotext Materials ad methods Results Discussio ad coclusio Cliical data Presece ad IWS type idepedet review by 2 radiologists Presece of pathologies by cosesus With histological proofs if preset Associated fidigs Coxofemoral joit effusio? Ilio psoas bursitis? Hip pai? Posterior to lumbar spie soft tissue oedema (PLSTE) Depedig o patiet age or heart/kidey isufficiecy but ot o spie pathology Shi, AJR, 2003 Geu, Diag Iterv Imagi, 2014
7 Cotext Materials ad methods Results Discussio ad coclusio IWS : RESULTS IWS : prevalece : 27%, PPV 96%, NPV 35% U-IWS ad BA-IWS: PPV=100% (84% for B-IWS) Ipsilateral pathology : U-IWS: 90% (low rate for other IWS types) rare ehacemet of IWS i case of gadoliium ijectio (4/27) Iter reader reliability: Kappa > 0.9
8 Cotext Materials ad methods Results Discussio ad coclusio Results : IWS ad cliical data Associatio Age Posterior to lumbar spie soft tissue oedema Coxofemoral joit effusio U-IWS + (OR=1,5) NS + (OR=1,98) BA-IWS + (OR=2,4) ++ (OR=15,7) + (OR=2,45) B-IWS + (OR=2,05) +++ (OR=20,6) NS OR : odds ratio ; NS : o sigificat No statistical associatio betwee IWS (all IWS type) ad : Ilio psoas bursitis Hip Pai Geder, weight, status
9 Cotext Materials ad methods Results Discussio ad coclusio 80% IWS prevalece give Mai Diseases P < 0.05 Prevalece i % /2 52% 12/11 30% 25% 24% 24% fracture maligat boe tumor 9/21 3/9 5/16 6/19 coxarthrosis osteoecrosis arthritis tediopathy beig boe tumor OR=6.2; rage, , p<0.001 Mai diseases 0/15 0%
10 Cotext Materials ad methods Results Discussio ad coclusio IWS prevalece give mai aatomical localizatios of pathologies 60 IWS prevalece i % % 12/12 28% 27% P > % 5/13 23/63 4/15 0 pelvic boes femoral boe hip gluteal muscles Mai aatomical localizatios
11 Cotext Materials ad methods Results Discussio ad coclusio What is IWS? Layer of like water High itesity o T2 weighted sequece with fat suppressio Ehacemet was uusual Eshed Vasogeic Oedema >> iflammatory tissue
12 Cotext Materials ad methods Results Discussio ad coclusio Physiopathology? 8% Arthro MRI (total 50) Kakigi Eshed
13 Cotext Materials ad methods Results Discussio ad coclusio Coclusio IWS is correlated with age Maily i bilateral type (B-IWS) IWS is a ipsilateral setiel sig Especially i U-IWS et BA-IWS types: PPV of pathology = 100% ad good localizatio skill Excellet iter reader reliability IWS is more ofte see I case of fracture I case of maligat boe tumor: idirect sig of eoplasia
14 Thaks for your attetio
n Progressive Osseous changes n Scapular and Cuff weakness n Post. Soft Tissue contracture n Post-sup. Instability in ABD and EXT ROT.
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