Objectives: This multicenter study was conducted to evaluate the diagnostic yield MRI and CT imaging and bone scintigraphy in patients with suspected tibial stress injury among military recruits.
Patients & Methods: Patients with unilateral lower leg discomfort lasting less than one-month, antalgic gait and/or decreased functional mobility and no history of trauma or indications of bone abnormalities on conventional radiography imaging of the lower leg were included in the research. MRI, CT, and bone scintigraphy were used to assess every patient.
Results: The patients had a mean (±SD) of 25±1.4 years and a mean pain duration of 18.9±6.9, range: 5-29 days. Mean pain score estimated at time of examination was 45.6±11.6, range: 25-70. MRI detected abnormalities in 40 patients, while CT examination and bone scintigraphy detected abnormalities in 21 and 28 patients, respectively with a significant increase of the frequency of detection of tibial abnormalities using MRI compared to CT and bone scintigraphy and a significant increase in favor of bone scintigraphy compared to CT. Marrow edema was detected in 23 patients using MRI and in 16 patients using bone scintigraphy but in only 2 patients using CT. On contrary, cortical abnormalities were detected in 15 patients using MRI and 12 patients using bone scintigraphy but were detected in 19 patients using CT. MRI detected cortical abnormalities with 79% sensitivity and 91% accuracy, while bone scintigraphy showed 63% and 84% re-spectively, versus CT that showed 100% sensitivity and accuracy for detecting cortical abnormalities. On the other hand, CT and scintigraphy showed a sensitivity of 9% and 70% and accuracy rate of 53% and 84%, respectively compared versus MRI that showed 100% sensitivity and accuracy for detection of marrow edema. MRI showed a significantly higher diagnostic yield in comparison to both other modalities with a significantly higher diagnostic yield of scintigraphy compared to CT.
Conclusion: Examining patients with suspected tibial stress should begin with MRI, however individuals with negative MRI results should have CT evaluation.
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