title: CT and MR imaging findings in athletes with early tibial stress injuries: comparison with bone scintigraphy findings and emphasis on cortical abnormalities.
abstract: OBJECTIVE
  To prospectively compare computed tomography (CT), magnetic resonance (MR) imaging, and bone scintigraphy in athletes with clinically suspected early stress injury of tibia.
  
  
  METHODS
  Medical ethics committee approval and informed consent were obtained. A total of 42 patients experiencing tibial pain due to early stress injuries were evaluated. Eight patients had bilateral involvement; thus, 50 tibiae were evaluated. All patients underwent initial radiography that was negative for injury. MR imaging, CT, and bone scintigraphy were performed in all patients within 1 month of onset of symptoms. Ten asymptomatic volunteers served as the control group. Location of stress injuries, types of bone alterations, and presence of periosteal and bone marrow edema were evaluated. Sensitivity, specificity, accuracy, and positive and negative predictive values of MR imaging and CT were assessed, as was sensitivity of bone scintigraphy. McNemar test was used to detect statistically significant differences.
  
  
  RESULTS
  Sensitivity of MR imaging, CT, and bone scintigraphy was 88%, 42%, and 74%, respectively. Specificity, accuracy, and positive and negative predictive values were 100%, 90%, 100%, and 62%, respectively, for MR imaging and 100%, 52%, 100%, and 26%, respectively, for CT. Significant difference in detection of early tibial stress injuries was found between MR imaging and both CT and bone scintigraphy (McNemar test; P < .001 and P = .008, respectively).
  
  
  CONCLUSIONS
  MR imaging is the single best technique in assessment of patients with suspected tibial stress injuries; in some patients with negative MR imaging findings, CT can depict osteopenia, which is the earliest finding of fatigue cortical bone injury.
authors.affiliation: Department of Radiological Sciences, University of Messina, Policlinico G. Martino, Via Consolare Valeria, 98100 Messina, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Gaeta
authors.forename: Fabio
authors.initials: F
authors.lastname: Minutoli
authors.forename: Emanuele
authors.initials: E
authors.lastname: Scribano
authors.forename: Giorgio
authors.initials: G
authors.lastname: Ascenti
authors.forename: Sergio
authors.initials: S
authors.lastname: Vinci
authors.forename: Daniele
authors.initials: D
authors.lastname: Bruschetta
authors.forename: Ludovico
authors.initials: L
authors.lastname: Magaudda
authors.forename: Alfredo
authors.initials: A
authors.lastname: Blandino
mesh_terms: D000293:Adolescent; D000328:Adult; D001265:Athletic Injuries / Q000175:diagnosis*; D003937:Diagnosis, Differential; D005188:False Negative Reactions; D005260:Female; D015775:Fractures, Stress / Q000175:diagnosis*; D006801:Humans; D007089:Image Enhancement; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008297:Male; D011446:Prospective Studies; D011877:Radionuclide Imaging; D012680:Sensitivity and Specificity; D013977:Tibia / Q000473:pathology*; D013978:Tibial Fractures / Q000175:diagnosis*; D014057:Tomography, X-Ray Computed