Radiographically negative stress related bone injury. MR imaging versus two-phase bone scintigraphy.
OBJECTIVE
To assess the diagnostic value of MR imaging relative to two-phase bone scintigraphy in radiographically negative stress-related injuries.


METHODS
Sixteen consecutive patients presenting with stress-related bone injuries and normal standard radiographs were examined with two-phase bone scans and MR imaging. MR imaging protocols varied according to the region to be examined. The MR and scintigraphic images were evaluated blindly and separately by respectively two radiologists and two nuclear medicine physicians. The standard of reference was represented by a combination of clinical and scintigraphic findings as well as clinical follow-up.


RESULTS
For MR imaging, sensitivity, specificity, and positive and negative predictive values for the presence of stress-related injuries for the two readers were 69/63%, 100/80%, 100/91%, and 50/40%, respectively. Interobserver agreement was good (kappa = 0.62). For scintigraphy, all abnormal and normal findings were correctly identified.


CONCLUSIONS
For patients with clinically suspected stress-related injuries and a low probability of other active bone diseases (such as infection or neoplasm), bone scintigraphy should be the initial imaging modality.
Department of Radiology, Balgrist Clinic, University of Zurich, Switzerland.
J
J
Hodler
H
H
Steinert
M
M
Zanetti
U
U
Frölicher
J
J
Rogala
K
K
Stumpe
G K
GK
von Schulthess
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001265:Athletic Injuries / Q000000981:diagnostic imaging* / Q000473:pathology*; D001842:Bone and Bones / Q000000981:diagnostic imaging* / Q000473:pathology*; D002648:Child; D002908:Chronic Disease; D004164:Diphosphonates; D005260:Female; D015775:Fractures, Stress / Q000000981:diagnostic imaging* / Q000473:pathology*; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000295:instrumentation / Q000379:methods; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D012680:Sensitivity and Specificity; D017556:Technetium Compounds
D004164:Diphosphonates; D019275:Radiopharmaceuticals; D017556:Technetium Compounds; C029045:technetium Tc 99m diphosphonate