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MRI Appearance of Chronic Stress Injury of the Iliac Crest Apophysis in Adolescent Athletes

¹ Department of Radiology, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, 3333 Burnet Ave., Cincinnati, OH 45229-3039.
² Division of Sports Medicine, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, OH.
³ Department of Orthopedic Surgery, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, OH.

View larger version (110K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1A —16-year-3-month-old male baseball player and cross-country runner with bilateral hip and right iliac crest pain (patient 2 in Table 1). Frontal view of pelvis shows minimal widening of physis adjacent to right iliac crest apophysis (arrow); original study did not include complete iliac crests.

View larger version (84K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1B —16-year-3-month-old male baseball player and cross-country runner with bilateral hip and right iliac crest pain (patient 2 in Table 1). Coronal fat-suppressed fast spin-echo T2-weighted image (TR/TE, 3,000/89) of pelvis shows bone marrow edema in right iliac crest. Physis (arrow) is minimally widened and of increased signal intensity compared with left side.

View larger version (129K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2A —16-year-10-month-old female dancer with right hip pain (patient 7 in Table 1). Frontal radiograph of pelvis shows symmetric irregularity and "lacy" widening of iliac crest apophyseal physes. Due to symmetry, this finding was not recognized prospectively.

View larger version (96K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2B —16-year-10-month-old female dancer with right hip pain (patient 7 in Table 1). Axial fat-suppressed T2-weighted image (TR/TE, 3,390/79) of pelvis shows bone marrow edema within iliac crests bilaterally, greater on right side than left side. Physeal widening (arrows), greater on right side than left side, is minimal. Minimal muscle edema is seen in both gluteus medius muscles.

View larger version (132K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2C —16-year-10-month-old female dancer with right hip pain (patient 7 in Table 1). Frontal radiograph obtained 7 months after A shows that irregular widening of iliac crest apophyses has improved. Bilateral apophyses show symmetric fragmentation, which is likely developmental.

View larger version (113K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3A —15-year-6-month-old female soccer player with 1 year of right hip pain (patient 6 in Table 1). Frogleg lateral view of pelvis shows mild widening of right iliac apophysis (arrow). Normal fragmentation is seen on right. Gonadal shield overlies pelvis.

View larger version (104K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3B —15-year-6-month-old female soccer player with 1 year of right hip pain (patient 6 in Table 1). Axial fat-suppressed fast spin-echo T2-weighted image (TR/TE, 3,970/79) of pelvis shows edema within right iliacus muscle (straight arrow) and gluteus medius muscle (curved arrow).

View larger version (117K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4 —16-year-1-month-old male golfer and track runner with lower back pain for 7 months (patient 3 in Table 1). Coronal fat-suppressed fast spin-echo T2-weighted image (TR/TE, 4,110/76) of pelvis shows edema within adjacent muscles (straight arrow) and right iliac crest. There also is a mild widening of right apophyseal physis (curved arrow).

View larger version (105K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4 —16-year-1-month-old male golfer and track runner with lower back pain for 7 months (patient 3 in Table 1). Sagittal fat-suppressed fast spin-echo T2-weighted image (3,090/71) of right iliac crest (asterisk) shows bone marrow and muscle edema.

View larger version (114K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5A —14-year-10-month-old female track runner with right hip and iliac crest pain (patient 5 in Table 1). Frogleg lateral radiograph shows mild widening of apophysis (arrow) of right iliac crest. This finding was not recognized at time of initial interpretation. Gonadal shield overlies pelvis.

View larger version (89K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5B —14-year-10-month-old female track runner with right hip and iliac crest pain (patient 5 in Table 1). Axial fat-suppressed T2-weighted image (TR/TE, 2,316/68) of pelvis shows minimal bone marrow edema and physeal widening (arrow) of right iliac apophysis. No muscle edema is seen.

View larger version (134K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5C —14-year-10-month-old female track runner with right hip and iliac crest pain (patient 5 in Table 1). Frontal radiograph obtained 7 weeks after B shows improvement in right iliac crest apophyseal widening.

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