title: High-resolution axial MR imaging of tibial stress injuries.
abstract: OBJECTIVE
  To evaluate the relative involvement of tibial stress injuries using high-resolution axial MR imaging and the correlation with MR and radiographic images.
  
  
  METHODS
  A total of 33 patients with exercise-induced tibial pain were evaluated. All patients underwent radiograph and high-resolution axial MR imaging. Radiographs were taken at initial presentation and 4 weeks later. High-resolution MR axial images were obtained using a microscopy surface coil with 60 × 60 mm field of view on a 1.5T MR unit. All images were evaluated for abnormal signals of the periosteum, cortex and bone marrow.
  
  
  RESULTS
  Nineteen patients showed no periosteal reaction at initial and follow-up radiographs. MR imaging showed abnormal signals in the periosteal tissue and partially abnormal signals in the bone marrow. In 7 patients, periosteal reaction was not seen at initial radiograph, but was detected at follow-up radiograph. MR imaging showed abnormal signals in the periosteal tissue and entire bone marrow. Abnormal signals in the cortex were found in 6 patients. The remaining 7 showed periosteal reactions at initial radiograph. MR imaging showed abnormal signals in the periosteal tissue in 6 patients. Abnormal signals were seen in the partial and entire bone marrow in 4 and 3 patients, respectively.
  
  
  CONCLUSIONS
  Bone marrow abnormalities in high-resolution axial MR imaging were related to periosteal reactions at follow-up radiograph. Bone marrow abnormalities might predict later periosteal reactions, suggesting shin splints or stress fractures. High-resolution axial MR imaging is useful in early discrimination of tibial stress injuries.
authors.affiliation: Department of Orthopaedic Surgery and Sports Medicine, Tsukuba University Hospital Mito Medical Center, Mito Kyodo General Hospital, 3-2-7, Miya-machi, Mito, Ibaraki, 310-0015, Japan.
authors.forename: Takeo
authors.initials: T
authors.lastname: Mammoto
authors.affiliation: Department of Orthopaedic Surgery and Sports Medicine, Tsukuba University Hospital Mito Medical Center, Mito Kyodo General Hospital, 3-2-7, Miya-machi, Mito, Ibaraki, 310-0015, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Hirano
authors.affiliation: Department of Orthopaedic Surgery and Sports Medicine, Tsukuba University Hospital Mito Medical Center, Mito Kyodo General Hospital, 3-2-7, Miya-machi, Mito, Ibaraki, 310-0015, Japan.
authors.forename: Yohei
authors.initials: Y
authors.lastname: Tomaru
authors.affiliation: Department of Orthopaedic Surgery and Sports Medicine, Tsukuba University Hospital Mito Medical Center, Mito Kyodo General Hospital, 3-2-7, Miya-machi, Mito, Ibaraki, 310-0015, Japan.
authors.forename: Mamoru
authors.initials: M
authors.lastname: Kono
authors.affiliation: Department of Orthopaedic Surgery and Sports Medicine, Tsukuba University Hospital Mito Medical Center, Mito Kyodo General Hospital, 3-2-7, Miya-machi, Mito, Ibaraki, 310-0015, Japan.
authors.forename: Yuta
authors.initials: Y
authors.lastname: Tsukagoshi
authors.affiliation: Department of Orthopaedic Surgery and Sports Medicine, Tsukuba University Hospital Mito Medical Center, Mito Kyodo General Hospital, 3-2-7, Miya-machi, Mito, Ibaraki, 310-0015, Japan.
authors.forename: Sinzo
authors.initials: S
authors.lastname: Onishi
authors.affiliation: Department of Orthopaedic Surgery and Sports Medicine, Tsukuba University Hospital Mito Medical Center, Mito Kyodo General Hospital, 3-2-7, Miya-machi, Mito, Ibaraki, 310-0015, Japan.
authors.forename: Naotaka
authors.initials: N
authors.lastname: Mamizuka