MR imaging, bone scintigraphy, and radiography in bone stress injuries of the pelvis and the lower extremity.
OBJECTIVE
To compare MR imaging, radiography and bone scintigraphy in the diagnosis of stress injuries to bones of the pelvis and lower extremity.


METHODS
Fifty consecutive conscripts with clinical signs of a stress injury to bone underwent MR imaging and bone scintigraphy. Forty-three patients also had radiographs available. Bone scintigraphy served as a gold standard.


RESULTS
Compared to the bone scintigraphy, the sensitivity of radiography was 56%, specificity 94%, accuracy 67%, positive predictive value (PPV) 95%, and negative predictive value (NPV) 48%. The kappa value for radiography and bone scintigraphy was fair (0.39). Correspondingly, the sensitivity of MR imaging was 100%, specificity 86%, accuracy 95%, PPV 93% and NPV 100%. The kappa value for MR imaging and bone scintigraphy was very good (0.89). MR imaging depicted 3 bone stress injuries that were not visible on bone scintigraphy. Positive findings obtained from radiography correlated with MR signs of fracture line or callus (p<0.001).


CONCLUSIONS
MR imaging is more sensitive than two-phase bone scintigraphy, and MR imaging should be used as the gold standard in the assessment of stress injuries of bone. Radiography reveals mainly the late phases of bone stress injuries, such as stress fracture and callus.
Kiuru
M J
MJ
Department of Radiology, Helsinki University Central Hospital, Finland.
Pihlajamaki
H K
HK
Hietanen
H J
HJ
Ahovuo
J A
JA
D000328:Adult; D001842:Bone and Bones / Q000000981:diagnostic imaging*; D005260:Female; D005387:Finland; D015775:Fractures, Stress / Q000175:diagnosis* / Q000000981:diagnostic imaging; D006801:Humans; D007867:Leg Bones / Q000293:injuries*; D008279:Magnetic Resonance Imaging; D008297:Male; D008889:Military Personnel; D010384:Pelvic Bones / Q000293:injuries*; D011237:Predictive Value of Tests; D011859:Radiography; D011877:Radionuclide Imaging; D012680:Sensitivity and Specificity