Musculoskeletal imaging: sacral insufficiency fracture: practice question

A Radiology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Radiology · Musculoskeletal imaging: sacral insufficiency fracture

Sample item

An elderly woman on long-term corticosteroids has low back and buttock pain without trauma, and her pelvic radiograph is unremarkable. A Tc-99m bone scan shows an H-shaped pattern of uptake in the sacrum. What is the diagnosis?

ASacral insufficiency fractureBSacroiliitisCPaget disease of the sacrumDSacral metastasis

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. Sacral insufficiency fracture

An H- or butterfly-shaped uptake across the sacrum (Honda sign) reflects bilateral vertical sacral ala fractures joined by a transverse component. Osteoporosis and steroids are risk factors, and plain films often miss it.

Option by option

A. Sacral insufficiency fracture (correct)
Correct. An H-shaped sacral uptake pattern in an osteoporotic patient is characteristic of an insufficiency fracture.
B. Sacroiliitis
Sacroiliitis gives uptake in the sacroiliac joints, not an H-shaped sacral pattern.
C. Paget disease of the sacrum
Paget disease shows diffuse uptake of an enlarged, coarsened bone.
D. Sacral metastasis
A sacral metastasis would give focal asymmetric uptake rather than a symmetrical H pattern.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this Radiology question

What is the answer to this Radiology question?

The best answer is A, Sacral insufficiency fracture. An H- or butterfly-shaped uptake across the sacrum (Honda sign) reflects bilateral vertical sacral ala fractures joined by a transverse component.

Why is "Sacroiliitis" not the answer?

Sacroiliitis gives uptake in the sacroiliac joints, not an H-shaped sacral pattern.

Why is "Paget disease of the sacrum" not the answer?

Paget disease shows diffuse uptake of an enlarged, coarsened bone.

Why is "Sacral metastasis" not the answer?

A sacral metastasis would give focal asymmetric uptake rather than a symmetrical H pattern.

What concept does this question test?

It tests Musculoskeletal imaging: sacral insufficiency fracture in Radiology. Osteoporosis and steroids are risk factors, and plain films often miss it.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Musculoskeletal imaging: sacral insufficiency fracture?

Learn signs with the image, and the disease they point to. Then use the flashcards and the other Radiology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.