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Imaging of Sacral Abnormalities

The name sacrum probably originates from the term “os sacrum,” a literal Roman translation of the Greek words hieron osteon, meaning “holv bone.” This bone was considered sacred to Osiris, the Egyptian god of resurrection and agriculture, and this fact may account for the association with holiness. Regardless of the origin for its name, however, the sacrum has several anatomic and radiographic distinctions. It is the largest of the vertebral elements. It also has the most extensive neural network. In addition, the main symptom of sacral abnormality, low back pain, can be caused b.v a number of other diseases, and the plain radiograph may not provide a good evaluation of the sacrum. Therefore, the radiologist should maintain a high level of suspicion for sacral pathology when evaluating patients with low back pain and should recommend cross-sectional studies-either computed tomography (CT) or magnetic resonance (MR) imaging for those with a high likelihood of sacral disease.Abnormalities of the sacrum can best be divided into congenital, traumatic, neoplastic, and inflammatory categories. A brief description of the important pathologic processes in each of these areas and an imaging algorithm for evaluating the sacrum are presented.