MRI Area of Interest Without and With IV Contrast There is no relevant literature to support the use of MRI area of interest without and with IV contrast because it does not provide added information over noncontrast imaging with regard to stress injury. MRI Area of Interest Without IV Contrast MRI is beneficial after initial negative radiographs to prevent delayed diagnosis. MRI has excellent sensitivity and allows for definitive diagnosis. Radiography Area of Interest Repeat In 10-14 Days In general, follow-up radiographic examination has increased sensitivity compared to initial radiographs [43]. However, subchondral insufficiency fractures are typically radiographically occult until collapse or flattening of the articular surface occurs, at which point morbidity is significantly increased. Therefore, MRI without IV contrast should be considered as the next imaging study after initial negative radiographs to prevent delay in diagnosis and preventative treatment. US Area of Interest US does not allow evaluation of subchondral bone and so provides no benefit in this scenario. Variant 6: Adult. Positive stress fracture on radiographs, excluding vertebrae. Need for determining extent (ie, for surgical planning, return to activity) or associated complication (ie, osteonecrosis or delayed healing). Next imaging study. Area of Interest: pelvis, ankle, elbow, femur, foot, forearm, hand, hip, humerus, knee, leg tib/fib, ribs, sacrum, shoulder, or wrist. After a diagnosis of stress fracture is made, additional imaging is typically not needed. Most patients are followed clinically until they are pain free, at which time they can increase activity in a controlled manner [14]. Fractures in the long bones may be followed up by radiography, CT, MRI, or a combination thereof as needed to determine full extent of involvement.
Stress Fatigue Insufficiency Fracture Including Sacrum Excluding Other Vertebrae PCAs. MRI Area of Interest Without and With IV Contrast There is no relevant literature to support the use of MRI area of interest without and with IV contrast because it does not provide added information over noncontrast imaging with regard to stress injury. MRI Area of Interest Without IV Contrast MRI is beneficial after initial negative radiographs to prevent delayed diagnosis. MRI has excellent sensitivity and allows for definitive diagnosis. Radiography Area of Interest Repeat In 10-14 Days In general, follow-up radiographic examination has increased sensitivity compared to initial radiographs [43]. However, subchondral insufficiency fractures are typically radiographically occult until collapse or flattening of the articular surface occurs, at which point morbidity is significantly increased. Therefore, MRI without IV contrast should be considered as the next imaging study after initial negative radiographs to prevent delay in diagnosis and preventative treatment. US Area of Interest US does not allow evaluation of subchondral bone and so provides no benefit in this scenario. Variant 6: Adult. Positive stress fracture on radiographs, excluding vertebrae. Need for determining extent (ie, for surgical planning, return to activity) or associated complication (ie, osteonecrosis or delayed healing). Next imaging study. Area of Interest: pelvis, ankle, elbow, femur, foot, forearm, hand, hip, humerus, knee, leg tib/fib, ribs, sacrum, shoulder, or wrist. After a diagnosis of stress fracture is made, additional imaging is typically not needed. Most patients are followed clinically until they are pain free, at which time they can increase activity in a controlled manner [14]. Fractures in the long bones may be followed up by radiography, CT, MRI, or a combination thereof as needed to determine full extent of involvement.