Comparison of Imaging Modalities for Evaluating Injury Severity and Predicting Recovery from Tibial Stress Fracture

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Title Comparison of Imaging Modalities for Evaluating Injury Severity and Predicting Recovery from Tibial Stress Fracture
Author Beck, Belinda Ruth; Bergman, Gabrielle; Arendt, Elizabeth; Miner, Mark; Klevansky, Alan; Matheson, Gordon; Hoffman, Andrew; Norling, Tracey Louise; Marcus, Robert
Publication Title Medicine and Science in Sports and Exercise
Year Published 2007
Place of publication USA
Publisher Lippencott WIlliams and Wilkins
Abstract Plain X-ray, triple phase technetium99 polyphosphonate bone scan (BS), magnetic resonance imaging (MRI) and/or computed tomography (CT) have been used to evaluate stress fracture. Multiple method imaging is expensive and may expose patients to unnecessary radiation, to minimal clinical advantage. There is a need to establish guidelines for the most appropriate imaging modality to diagnose and prognosticate stress fracture injury. PURPOSE To identify the imaging modality that best predicts tibial stress fracture severity and recovery time. METHODS A convenience sample of 50 patients with tibial stress fracture was recruited. Subjects were examined acutely on the same or subsequent days via standard AP and lateral radiographs, BS, MRI and CT. A repeat MRI was obtained within 3 days of healing (asymptomatic with hopping). Examinations were graded on 0-4 modality-specific severity scales by 4 reviewers (2 stress fracture-specialist musculoskeletal radiologists, 1 non-specialist musculoskeletal radiologist, and 1 stress fracture-specialist orthopaedic surgeon). The relationships of image grade to clinical severity and time to healing were examined via correlation analyses. The predictive abilities of each imaging modality were examined via multiple regression analyses. The reliability of the grading system was evaluated via repeated measures ANOVA and Cronbach's alpha coefficient. RESULTS Despite moderate to good inter-grader correlations for all imaging modalities (range: r = 0.326 - 0.862, p < 0.05, two-tailed) and robust Cronbach's alpha reliability coefficients for the grading system (range: 0.591 - 0.895), no imaging modality consistently predicted tibial stress fracture clinical injury severity. When only two graders were included in the regression model, however, BS grade predicted clinical severity (R2 = 0.138, p = 0.03). BS grade also predicted time to healing (R2 = 0.241, p =.007), as did a combined radiology score of all imaging modalities (R2 = 0.243, p = 0.03) including all graders. CONCLUSION Tibial stress fracture clinical severity bears poor relationship to the appearance of severity on diagnostic imaging. BS was the most effective imaging modality for tibial stress fracture prognostication. Supported by US Army MRMC, DAMD17-98-1-8519, and BIOLECTRON, Inc. now EBI, Parsippany, NJ.
Peer Reviewed No
Published Yes
Conference name American Colege of Sports Medicine
Location New Orleans
Date From 2007-05-30
Date To 2007-06-02
Date Accessioned 2007-07-02
Language en_AU
Research Centre Menzies Health Institute Qld; Centre for Musculoskeletal Research
Faculty Griffith Health Faculty
Subject Radiology and Organ Imaging
Publication Type Conference Publications (Extract Paper)
Publication Type Code e3

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