J. Hodler et al., RADIOGRAPHICALLY NEGATIVE STRESS-RELATED BONE INJURY - MR-IMAGING VERSUS 2-PHASE BONE-SCINTIGRAPHY, Acta radiologica, 39(4), 1998, pp. 416-420
Purpose. To assess the diagnostic value of MR imaging relative to two-
phase bone scintigraphy in radiographically negative stress-related in
juries. Material and Methods. Sixteen consecutive patients presenting
with stress-related bone injuries and normal standard radiographs were
examined with two-phase bone scans and MR imaging. MR imaging protoco
ls varied according to the region to be examined. The MR and scintigra
phic images were evaluated blindly and separately by respectively two
radiologists and two nuclear medicine physicians. The standard of refe
rence was represented by a combination of clinical and scintigraphic f
indings as well as clinical follow-up. Results: For MR imaging, sensit
ivity, specificity, and positive and negative predictive values for th
e presence of stress-related injuries for the two readers were 69/63%,
100/80%, 100/91%, and 50/40%, respectively. Interobserver agreement w
as good (kappa=0.62). For scintigraphy, all abnormal and normal findin
gs were correctly identified. Conclusion: For patients with clinically
suspected stress-related injuries and a low probability of other acti
ve bone diseases (such as infection or neoplasm), bone scintigraphy sh
ould be the initial imaging modality.