title: Validation of MRI classification system for tibial stress injuries.
abstract: OBJECTIVE
  The purpose of our study was to compare an MRI classification system for tibial stress injuries with semiquantitative MR features of injury severity and clinical outcome.
  
  
  METHODS
  Two musculoskeletal radiologists retrospectively reviewed in consensus the MR findings of 142 tibial stress injuries to quantify the degree of periosteal and bone marrow edema and grade the injuries using the Fredericson classification system (grade 1 = periosteal edema only, grade 2 = bone marrow edema visible on T2-weighted images, grade 3 = bone marrow edema visible on T1-weighted and T2-weighted images, grade 4a = multiple focal areas of intracortical signal abnormality, and grade 4b = linear areas of intracortical signal abnormality). Kruskal-Wallis tests were used to determine the relationship between the grade of stress injury and the degree of periosteal and bone marrow edema and the time to return to sports activity.
  
  
  RESULTS
  Grade 4b injuries had significantly (p < 0.002) more severe and grade 1 injuries less severe periosteal and bone marrow edema than grades 2, 3, and 4a injuries. Grade 4b injuries had significantly (p < 0.002) longer time and grade 1 injuries shorter time to return to sports activity than grades 2, 3, and 4a injuries. There was no significant difference (p = 0.06-0.79) among grades 2, 3, and 4a injuries in the degree of periosteal and bone marrow edema and the time to return to sports activity.
  
  
  CONCLUSIONS
  Grades 2, 3, and 4a stress injuries had similar degrees of periosteal and bone marrow edema and similar time to return to sports activity, which suggests that these three grades can be combined into a single category in an abbreviated Fredericson classification system.
authors.affiliation: Department of Radiology, University of Wisconsin, Clinical Science Center, Madison, 53792-3252, USA. rkijowski@uwhealth.org
authors.forename: Richard
authors.initials: R
authors.lastname: Kijowski
authors.forename: James
authors.initials: J
authors.lastname: Choi
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Shinki
authors.forename: Alejandro Munoz
authors.initials: AM
authors.lastname: Del Rio
authors.forename: Arthur
authors.initials: A
authors.lastname: De Smet
mesh_terms: D000293:Adolescent; D000328:Adult; D001265:Athletic Injuries / Q000145:classification* / Q000175:diagnosis; D001853:Bone Marrow / Q000293:injuries; D004487:Edema / Q000175:diagnosis; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010521:Periosteum / Q000293:injuries; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D013977:Tibia / Q000293:injuries*