title: Ultrasound as a primary evaluation tool of bone stress injuries in elite track and field athletes.
abstract: BACKGROUND
  Little is known about therapeutic ultrasound (TUS) to diagnose bone stress injuries.
  
  
  OBJECTIVE
  Therapeutic ultrasound is an accurate, cost-efficient alternative to other imaging methods for primary assessment of bone stress injuries.
  
  
  METHODS
  Cohort study (diagnosis); Level of evidence, 2.
  
  
  METHODS
  One hundred thirteen elite track and field athletes (mean age, 20.1 years; range, 17-28 years) underwent TUS and magnetic resonance imaging (MRI) for clinical suspicion of a bone stress injury. A 5-stage MRI grading system was used to classify bone stress injuries. Sensitivity, specificity, accuracy, and positive and negative predictive values of TUS were calculated using MRI as the standard for diagnosis.
  
  
  RESULTS
  At MRI, of 113 assessed patients, 3 (2.7%) had grade 0 injuries, 12 (10.6%) had grade 1, 15 (13.3%) had grade 2, 77 (68.2%) had grade 3, and 6 (5.3%) had grade 4. At TUS, no injury was detected in 22 of 113 patients: 2 with grade 0 injury, 8 with grade 1, 8 with grade 2, and 4 with grade 3. Using MRI as the gold standard, TUS showed 81.8% sensitivity, 66.6% specificity, 99.0% positive predictive value, 13.4% negative predictive value, and 81.4% accuracy.
  
  
  CONCLUSIONS
  Therapeutic ultrasound is a reproducible procedure that is reliable to diagnose bone stress injuries.
authors.affiliation: National Track & Field Centre, Sports Medicine Clinic of SEGAS, Thessaloniki, Greece.
authors.forename: Agapi
authors.initials: A
authors.lastname: Papalada
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Malliaropoulos
authors.forename: Kostas
authors.initials: K
authors.lastname: Tsitas
authors.forename: Olga
authors.initials: O
authors.lastname: Kiritsi
authors.forename: Nat
authors.initials: N
authors.lastname: Padhiar
authors.forename: Angelo
authors.initials: A
authors.lastname: Del Buono
authors.forename: Nicola
authors.initials: N
authors.lastname: Maffulli
mesh_terms: D000293:Adolescent; D000328:Adult; D056352:Athletes; D015331:Cohort Studies; D005260:Female; D015775:Fractures, Stress / Q000145:classification / Q000000981:diagnostic imaging*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D014142:Track and Field / Q000293:injuries*; D014463:Ultrasonography; D055815:Young Adult