Can an MRI be used to diagnose a tibial stress fracture?

Asked by mirifique (1540

) January 29th, 2010

I had bilateral shin splints from overuse (running, soccer, etc.) last October which my doctor diagnosed a “stress reaction” which could turn into stress fractures; the treatment was to stop running and gradually increase my exercise, which I did for 3 months. I started playing soccer again in January and shin pain returned, so my doctor wants to do a bone scan to confirm a stress fracture. However I’m concerned about the high radiation involved in a bone scan (approx. 400x that of an X-ray), and from various friends/internet sources, I’ve learned that MRI’s, which emit much less (if any) radiation, have been used to diagnose stress fractures, although I am not sure about tibial stress fractures. However is this really something I can negotiate with my doctor. On the one hand, I don’t want to be awkward or challenge his opinion, but on the other, I don’t want unnecessary radiation and then be paranoid for the rest of my life about developing cancer.

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3 Answers

Yes. I had the same thing, and the only way they found it was MRI.

Dr_Dredd (10540

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It looks like, from this article that an MRI is a possibility instead of a bone scan, in fact, in some instances it is preferred.

“If the plain film turns out to be negative, which is quite frequently the case, than magnetic resonance imaging (MRI) or bone scintigraphy should be considered to further evaluate the clinical finding.

The advantage of MRI is better spatial resolution and specificity. MRI can easily detect minor stress reactions, such as bone contusions on a short T1 inversion recovery (STIR) sequence or a fat-suppressed T2-weighted fast spin echo (FSE) sequence. If in addition the typical linear low signal component is identified, then the classic criteria for a stress fracture are present (see Image below and Image 2 in Multimedia).”

marinelife (62485

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If you are not comfortable enough suggesting another diagnostic technique to your doctor then it is time to find another doctor. There are absolutely physicians out there who do not like to be questioned but there are many out there who will relish the opportunity to actually discuss treatment with someone who has done their homework.

Clinically an MRI seems the best way to go here, less radiation and better data obtained. I do not know the corresponding costs though, so fiscally it may not be an option.

tekn0lust (1868

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