Imaging of Sacral Tumors

Betty Jean Manaster, MD, PhD, Travis Graham, MD


Neurosurg Focus. 2003;15(2) 

In This Article

Abstract and Introduction


Sacral tumors are somewhat unique to the skeletal system in that the prevalence of various neoplasms is different from that at other osseous sites. There are also unique imaging-related considerations, related in part to diagnosis, but particularly to the evaluation site for tumor biopsy sampling and resection. In this report, the authors describe imaging features of the most common sacral lesions, provide numerous radiological examples, and give suggestions for optimal imaging of this region of the body.


Imaging tumors of the sacrum can be a challenge in three respects. First, the lesion can be extremely difficult to detect radiographically, which is usually the initial choice of imaging. Second, there are a number of lesions that are predisposed to primary sacral involvement. Some have a prevalence by patient age group. Others have distinctive features, but many do not. The correct diagnosis requires knowledge of these features, as well as an understanding of how best to demonstrate them radiologically. Finally, the site of involvement must be accurately assessed. Locating the lesion and describing the tumor characteristics alone are not sufficient. To plan and achieve appropriate treatment, a precise evaluation of osseous and soft-tissue extent, as well as involvement of other pelvic structures, must be attained. Because of the oblique orientation of the sacrum, care must be taken to perform the most appropriate imaging suited to the anatomical site. We describe the most frequently encountered sacral neoplasms in the context of the aforementioned concerns.