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Comparison of Planar Scintigraphy Alone and with SPECT for the Initial Evaluation of Femoral Neck Stress Fracture

L. Ray Bryant1, Won S. Song1,2, Kevin P. Banks1, Liem T. Bui-Mansfield1,2 and Yong C. Bradley1,2

1 Department of Radiology and Nuclear Medicine, Brooke Army Medical Center, Fort Sam Houston, TX 78234.
2 Uniformed Services University of the Health Sciences, Bethesda, MD.


Figure 1
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  		Fig. 1A —18-year-old woman who complained of right hip pain. Anterior (A) and posterior (B) planar magnification images of hips and pelvis show subtle increased scintigraphic activity in medial margin of right femoral neck suspect for stress fracture.

 

Figure 2
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  		Fig. 1B —18-year-old woman who complained of right hip pain. Anterior (A) and posterior (B) planar magnification images of hips and pelvis show subtle increased scintigraphic activity in medial margin of right femoral neck suspect for stress fracture.

 

Figure 3
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  		Fig. 1C —18-year-old woman who complained of right hip pain. D, Small-field-of-view coronal images using STIR technique (C) and T2-weighted technique with fat saturation (D) of right hip show subchondral bone marrow edema along compressive side of femoral neck consistent with stress fracture.

 

Figure 4
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  		Fig. 1D —18-year-old woman who complained of right hip pain. Small-field-of-view coronal images using STIR technique (C) and T2-weighted technique with fat saturation (D) of right hip show subchondral bone marrow edema along compressive side of femoral neck consistent with stress fracture.

 

Figure 5
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  		Fig. 2A —22-year-old woman who complained of left hip pain. Anterior (A) and posterior (B) planar magnification images of hips and pelvis show mildly increased scintigraphic activity in bilateral femoral necks; this finding was considered to be stress changes without discrete stress fracture.

 

Figure 6
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  		Fig. 2B —22-year-old woman who complained of left hip pain. Anterior (A) and posterior (B) planar magnification images of hips and pelvis show mildly increased scintigraphic activity in bilateral femoral necks; this finding was considered to be stress changes without discrete stress fracture.

 

Figure 7
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  		Fig. 2C —22-year-old woman who complained of left hip pain. Coronal STIR MR image through bilateral hips and pelvis shows abnormal subchondral bone marrow edema in both femoral necks, with left more significantly affected than right.

 

Figure 8
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  		Fig. 2D —22-year-old woman who complained of left hip pain. Small-field-of-view coronal T2-weighted images obtained using fat-saturation technique of right (D) and left (E) hips more clearly depict bilateral stress fractures than A–C.

 

Figure 9
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  		Fig. 2E —22-year-old woman who complained of left hip pain. Small-field-of-view coronal T2-weighted images obtained using fat-saturation technique of right (D) and left (E) hips more clearly depict bilateral stress fractures than A–C.

 

Figure 10
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  		Fig. 3A —25-year-old woman who complained of right hip pain. Anterior (A) and posterior (B) planar magnification images of hips and pelvis show no focal activity suspect for stress fracture or other acute osseous pathology.

 

Figure 11
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  		Fig. 3B —25-year-old woman who complained of right hip pain. Anterior (A) and posterior (B) planar magnification images of hips and pelvis show no focal activity suspect for stress fracture or other acute osseous pathology.

 

Figure 12
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  		Fig. 3C —25-year-old woman who complained of right hip pain. Coronal SPECT image of hips and pelvis reveals abnormal focal activity (arrow) in medial margin of right femoral neck, near lesser trochanter.

 

Figure 13
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  		Fig. 3D —25-year-old woman who complained of right hip pain. Small-field-of-view coronal images obtained using T2-weighted technique with fat saturation (D) and STIR technique (E) of right hip show subchondral bone marrow edema along compressive side of femoral neck consistent with stress fracture.

 

Figure 14
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  		Fig. 3E —25-year-old woman who complained of right hip pain. Small-field-of-view coronal images obtained using T2-weighted technique with fat saturation (D) and STIR technique (E) of right hip show subchondral bone marrow edema along compressive side of femoral neck consistent with stress fracture.

 

Figure 15
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  		Fig. 4A —18-year-old woman who complained of left hip pain. Anterior planar image of hips and pelvis shows focal activity involving left femoral neck consistent with stress fracture.

 

Figure 16
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  		Fig. 4B —18-year-old woman who complained of left hip pain. Coronal SPECT image through bilateral hips and pelvis not only confirms left femoral neck stress fracture, but also reveals unsuspected abnormal activity in right femoral neck.

 

Figure 17
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  		Fig. 4C —18-year-old woman who complained of left hip pain. Coronal MR STIR image through bilateral hips and pelvis shows left femoral neck stress as well as abnormal subchondral bone marrow edema in right femoral neck and joint effusion, confirming presence of bilateral femoral neck stress fractures.

 

Figure 18
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  		Fig. 4D —18-year-old woman who complained of left hip pain. Small-field-of-view coronal STIR image better depicts abnormal findings of right hip than A–C.

 

Figure 19
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  		Fig. 5A —21-year-old woman who complained of right hip pain. Anterior (A) and posterior (B) planar magnification images of hips and pelvis show no focal activity suspect for stress fracture or other acute osseous abnormalities.

 

Figure 20
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  		Fig. 5B —21-year-old woman who complained of right hip pain. Anterior (A) and posterior (B) planar magnification images of hips and pelvis show no focal activity suspect for stress fracture or other acute osseous abnormalities.

 

Figure 21
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  		Fig. 5C —21-year-old woman who complained of right hip pain. Small-field-of-view coronal images obtained using T2-weighted technique with fat saturation (C) and STIR technique (D) of right hip show subchondral bone marrow edema along compressive side of femoral neck consistent with stress fracture.

 

Figure 22
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  		Fig. 5D —21-year-old woman who complained of right hip pain. Small-field-of-view coronal images obtained using T2-weighted technique with fat saturation (C) and STIR technique (D) of right hip show subchondral bone marrow edema along compressive side of femoral neck consistent with stress fracture.

 

Figure 23
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  		Fig. 6 —Bar graph shows sensitivity, specificity, and accuracy of grading femoral neck stress fracture for planar scintigraphy alone (white) and planar scintigraphy with SPECT (dark gray). Difference in sensitivity, was not significant (p = 0.03, Fisher t test) after Bonferroni correction for multiple comparisons. Difference in grading for high-grade fracture was not significant (p = 0.025, Fisher t test) after Bonferroni correction for multiple comparisons.

 

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