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Asymptomatic Tibial Stress Reactions: MRI Detection and Clinical Follow-Up in Distance Runners

A. Gabrielle Bergman1,2, Michael Fredericson3, Charles Ho4 and Gordon O. Matheson5

1 Department of Radiology, Stanford University Medical Center, 300 Pasteur Dr., Stanford, CA 94305-5105.
2 Present address: Franklin & Seidelmann Virtual Radiologists, El Dorado Hills, CA.
3 Department of Orthopaedic Surgery, Division of Physical Medicine and Rehabilitation, Stanford University Medical Center, Stanford, CA 94305-5336.
4 Sand Hill Imaging, Menlo Park, CA 94025.
5 Department of Orthopaedic Surgery, Division of Sports Medicine, Burnham Pavilion, Stanford University, Stanford, CA 94305-6175.



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  		Fig. 1. —18-year-old asymptomatic female college distance runner with bilateral grade 1 stress reaction of tibia. Axial T2-weighted fast spin-echo image (TR/TE, 5,000/102) with fat saturation shows periosteal edema (arrows), but tibial bone marrow signal remains normal bilaterally, similar to adjacent subcutaneous fat. Vascular structures may mimic periosteal edema, so it is necessary to evaluate several adjacent images. Periosteal edema was present on 12 contiguous images in this individual, representing cephalo-caudad length of 9.6 cm.

 


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  		Fig. 2. —19-year-old asymptomatic male college distance runner with grade 2 stress reaction of right tibia. Axial T2-weighted fast spin-echo image (TR/TE, 5,000/96) with fat saturation shows periosteal edema posteriorly along tibia (straight arrow) and bone marrow edema (curved arrow). Normal low marrow signal is seen in left tibia.

 


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  		Fig. 3A. —18-year-old asymptomatic male college distance runner with grade 3 stress reaction in right tibia. Axial T1-weighted (A) and T2-weighted (B) images show subtle periosteal edema (straight solid arrow, B), with adjacent bone marrow edema (curved arrow). Normal nutrient vessel (open arrows, B) is shown in posterior midline tibial cortex.

 


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  		Fig. 3B. —18-year-old asymptomatic male college distance runner with grade 3 stress reaction in right tibia. Axial T1-weighted (A) and T2-weighted (B) images show subtle periosteal edema (straight solid arrow, B), with adjacent bone marrow edema (curved arrow). Normal nutrient vessel (open arrows, B) is shown in posterior midline tibial cortex.

 


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  		Fig. 4. —18-year-old asymptomatic female college distance runner with muscle strain in lateral head of gastroc-nemius muscle. Axial T2-weighted fast spin-echo image (TR/TE, 5,000/102) with fat saturation shows edema in muscle (arrow) and along adjacent fascial planes.

 


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  		Fig. 5. —19-year-old asymptomatic male college distance runner. Sagittal T2-weighted fast spin-echo image (TR/TE, 5,000/96) with fat saturation shows normal finding in tibial bone marrow (asterisk) and posterior tibial cortex with nutrient vessel traversing cortex (straight arrow) and its intraosseous branches (curved arrow) that may mimic tibial stress lesion.

 

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