Thus, there will be focal uptake in any location of new bone formation. Although bone scintigraphy is very sensitive for stress reactions, including subchondral stress fractures, in most cases it lacks specificity, with synovitis, arthritis, degenerative joint disease, stress reactions, and tumor appearing similar. Supplemental imaging with MRI may be necessary for conclusive diagnosis or to avoid false positives [66]. Because planar bone scintigraphy is often nonspecific and supplemental imaging is frequently required, there is consensus in the literature that cross-sectional imaging should supersede planar bone scintigraphy as the imaging of choice for suspected stress fractures when the radiograph is negative [31]. CT Area of Interest With IV Contrast There is no relevant literature to support the use of CT area of interest with IV contrast because it does not provide added information over noncontrast imaging with regard to stress injury. CT Area of Interest Without and With IV Contrast There is no relevant literature to support the use of CT area of interest without and with IV contrast because it does not provide added information over noncontrast imaging with regard to stress injury. Stress (Fatigue-Insufficiency) Fracture CT Area of Interest Without IV Contrast CT is not supported as the next imaging study for suspected subchondral stress fractures following radiographs but may offer an adjunctive role when other imaging modalities are equivocal [22]. Although superior to radiography, it is less sensitive than nuclear scintigraphy or MRI [23]. The value of CT in the setting of suspected subchondral stress fracture primarily lies in detection of articular surface collapse and sclerosis that could indicate secondary necrosis. CT is useful in cases in which MRI results are equivocal.
Stress Fatigue Insufficiency Fracture Including Sacrum Excluding Other Vertebrae PCAs. Thus, there will be focal uptake in any location of new bone formation. Although bone scintigraphy is very sensitive for stress reactions, including subchondral stress fractures, in most cases it lacks specificity, with synovitis, arthritis, degenerative joint disease, stress reactions, and tumor appearing similar. Supplemental imaging with MRI may be necessary for conclusive diagnosis or to avoid false positives [66]. Because planar bone scintigraphy is often nonspecific and supplemental imaging is frequently required, there is consensus in the literature that cross-sectional imaging should supersede planar bone scintigraphy as the imaging of choice for suspected stress fractures when the radiograph is negative [31]. CT Area of Interest With IV Contrast There is no relevant literature to support the use of CT area of interest with IV contrast because it does not provide added information over noncontrast imaging with regard to stress injury. CT Area of Interest Without and With IV Contrast There is no relevant literature to support the use of CT area of interest without and with IV contrast because it does not provide added information over noncontrast imaging with regard to stress injury. Stress (Fatigue-Insufficiency) Fracture CT Area of Interest Without IV Contrast CT is not supported as the next imaging study for suspected subchondral stress fractures following radiographs but may offer an adjunctive role when other imaging modalities are equivocal [22]. Although superior to radiography, it is less sensitive than nuclear scintigraphy or MRI [23]. The value of CT in the setting of suspected subchondral stress fracture primarily lies in detection of articular surface collapse and sclerosis that could indicate secondary necrosis. CT is useful in cases in which MRI results are equivocal.