about monitoring stress injury of the talar dome with dynamic MRI and CBCT exam
Today I present you the clinical picture of a medial talar bone edema and spongious impaction of an elite runner; I’d like to remind you that a bone bruise is a subchondral osseous fracture of the cancellous microarchitecture with accompanied local hemorrhage and edema, so less indication for ultrasound imaging in this case. Yes, with ultrasound we can perfectly see the cortical irregularity but nothing about the definitive staging of the disease, so don’t forget: MRI is the method of choice (Stress Fracture in Runners).
Three months after the study was completed with Cone-Beam Ct scan; try to identify risk factors and training errors predisposing to stress fractures is mandatory.
I always use the dynamic MRI-CBCT examination before the return to activity.
Today a show you the case of a young football player that came to my observation for a persistent pain on his postero-medial compartment of the leg; as you can see from the dynamic ultrasound examination, a gross irregularity of the cortical tibial surface was evident with intense periostal hypervascularity.
The tibia is the most common site of a stress fracture in the lower body, especially in young athletes. Don’t forget that sensibility of the ultrasound scan with bone-like structures is 100% but 0% specificity. The integration with other imaging modalities is always needed; Mri exam is essential.
Sagittal Stir-3D Shark-T1w Mri scans 0.3 Tesla (from left to right)
Axial Stir (left) and T2w (right) Mri scans (0.3 Tesla); intense periostal reaction is evident.
With plain radiograph positive findings may take months to appear; don’t be surprised if during the first few weeks after the onset of symptoms, x-rays of the damaged area may look normal; not in this case….
Plain radiographs of the same patient: acute phase (left) and two months after (right).