Tibial Bone Stress Injury: Diagnostic Performance and Inter-reader Agreement of an Abbreviated 5-min Magnetic Resonance Protocol

Overview

Journal Skeletal Radiol

Specialties Orthopedics
Radiology

Date 2019 Aug 18

PMID 31420694

Authors

Jessica R Mann

Ged G Wieschhoff

Ryan Tai

William C Wrobel

Nehal Shah

Jacob C Mandell

Affiliations

Soon will be listed here.

Abstract

Objective: To compare the diagnostic performance and inter-reader agreement of an abbreviated (5 min) MR protocol compared to a complete (25 min) protocol, for evaluation of suspected tibial bone stress injury.

Materials And Methods: This IRB-approved retrospective study consisted of 95 consecutive MR examinations in 88 patients with suspected tibial bone stress injury. Three musculoskeletal radiologists independently classified all examinations utilizing both an abbreviated protocol consisting only of axial T2-weighted images with fat suppression, and after a washout period again classified the complete examinations. Accuracy was calculated as proportion of cases classified exactly, within 1 grade, within 2 grades, and also utilizing a simplified "clinically relevant" classification combining grades 2, 3, and 4A into a single group. Significance testing was performed with the chi-test, and a post-hoc power analysis was performed. Inter-reader agreement was calculated with Kendall's coefficient of concordance, with significance testing performed utilizing the z-test after bootstrapping to obtain the standard error.

Results And Conclusions: There was no significant difference in accuracy of grading tibial bone stress injuries between complete and abbreviated examinations. For complete exams, pooled exact accuracy was 47.8%; accuracy within 1 grade was 82.8%; and accuracy within 2 grades was 96.1%. For the abbreviated protocol, corresponding accuracies were 50.2, 82.0, and 93.9%. With the "clinically relevant" simplified classification, accuracy was 58.6% for complete exams and 64.2% for abbreviated exams. There was no significant difference in inter-reader agreement, with substantial agreement demonstrated for both complete (Kendall coefficient of concordance 0.805) and abbreviated examinations (coefficient of 0.767).

References

Subhas N, Benedick A, Obuchowski N, Polster J, Beltran L, Schils J . Comparison of a Fast 5-Minute Shoulder MRI Protocol With a Standard Shoulder MRI Protocol: A Multiinstitutional Multireader Study. AJR Am J Roentgenol. 2017; 208(4):W146-W154. DOI: 10.2214/AJR.16.17041. View

Sayah A, Jay A, Toaff J, Makariou E, Berkowitz F . Effectiveness of a Rapid Lumbar Spine MRI Protocol Using 3D T2-Weighted SPACE Imaging Versus a Standard Protocol for Evaluation of Degenerative Changes of the Lumbar Spine. AJR Am J Roentgenol. 2016; 207(3):614-20. DOI: 10.2214/AJR.15.15764. View

Hadid A, Moran D, Evans R, Fuks Y, Schweitzer M, Shabshin N . Tibial stress changes in new combat recruits for special forces: patterns and timing at MR imaging. Radiology. 2014; 273(2):483-90. DOI: 10.1148/radiol.14131882. View

Lee S, Han Lee Y, Suh J . Accelerating knee MR imaging: Compressed sensing in isotropic three-dimensional fast spin-echo sequence. Magn Reson Imaging. 2017; 46:90-97. DOI: 10.1016/j.mri.2017.10.018. View

Mandell J, Khurana B, Smith S . Stress fractures of the foot and ankle, part 2: site-specific etiology, imaging, and treatment, and differential diagnosis. Skeletal Radiol. 2017; 46(9):1165-1186. DOI: 10.1007/s00256-017-2632-7. View

Longo M, Fagundes J, Huang S, Mehan W, Witzel T, Bhat H . Simultaneous Multislice-Based 5-Minute Lumbar Spine MRI Protocol: Initial Experience in a Clinical Setting. J Neuroimaging. 2017; 27(5):442-446. DOI: 10.1111/jon.12453. View

Wilson Jr E, Katz F . Stress fractures. An analysis of 250 consecutive cases. Radiology. 1969; 92(3):481-6 passim. DOI: 10.1148/92.3.481. View

Fredericson M, Jennings F, Beaulieu C, Matheson G . Stress fractures in athletes. Top Magn Reson Imaging. 2007; 17(5):309-25. DOI: 10.1097/RMR.0b013e3180421c8c. View

Hostetter J, Khanna N, Mandell J . Integration of a Zero-footprint Cloud-based Picture Archiving and Communication System with Customizable Forms for Radiology Research and Education. Acad Radiol. 2018; 25(6):811-818. DOI: 10.1016/j.acra.2018.01.031. View

10.

Wright A, Hegedus E, Lenchik L, Kuhn K, Santiago L, Smoliga J . Diagnostic Accuracy of Various Imaging Modalities for Suspected Lower Extremity Stress Fractures: A Systematic Review With Evidence-Based Recommendations for Clinical Practice. Am J Sports Med. 2015; 44(1):255-63. DOI: 10.1177/0363546515574066. View

11.

Mandell J, Khurana B, Smith S . Stress fractures of the foot and ankle, part 1: biomechanics of bone and principles of imaging and treatment. Skeletal Radiol. 2017; 46(8):1021-1029. DOI: 10.1007/s00256-017-2640-7. View

12.

Kijowski R, Choi J, Shinki K, Rio A, De Smet A . Validation of MRI classification system for tibial stress injuries. AJR Am J Roentgenol. 2012; 198(4):878-84. DOI: 10.2214/AJR.11.6826. View

13.

Landis J, Koch G . The measurement of observer agreement for categorical data. Biometrics. 1977; 33(1):159-74. View

14.

Bossuyt P, Reitsma J, Bruns D, Gatsonis C, Glasziou P, Irwig L . STARD 2015: An Updated List of Essential Items for Reporting Diagnostic Accuracy Studies. Radiology. 2015; 277(3):826-32. DOI: 10.1148/radiol.2015151516. View

15.

Fritz J, Fritz B, Thawait G, Meyer H, Gilson W, Raithel E . Three-Dimensional CAIPIRINHA SPACE TSE for 5-Minute High-Resolution MRI of the Knee. Invest Radiol. 2016; 51(10):609-17. DOI: 10.1097/RLI.0000000000000287. View

16.

Kalia V, Fritz B, Johnson R, Gilson W, Raithel E, Fritz J . CAIPIRINHA accelerated SPACE enables 10-min isotropic 3D TSE MRI of the ankle for optimized visualization of curved and oblique ligaments and tendons. Eur Radiol. 2017; 27(9):3652-3661. DOI: 10.1007/s00330-017-4734-y. View

17.

Iwamoto J, Takeda T . Stress fractures in athletes: review of 196 cases. J Orthop Sci. 2003; 8(3):273-8. DOI: 10.1007/s10776-002-0632-5. View

18.

Fredericson M, Bergman A, Hoffman K, Dillingham M . Tibial stress reaction in runners. Correlation of clinical symptoms and scintigraphy with a new magnetic resonance imaging grading system. Am J Sports Med. 1995; 23(4):472-81. DOI: 10.1177/036354659502300418. View

19.

Wang B, Fintelmann F, Kamath R, Kattapuram S, Rosenthal D . Limited magnetic resonance imaging of the lumbar spine has high sensitivity for detection of acute fractures, infection, and malignancy. Skeletal Radiol. 2016; 45(12):1687-1693. DOI: 10.1007/s00256-016-2493-5. View

20.

Altahawi F, Blount K, Morley N, Raithel E, Omar I . Comparing an accelerated 3D fast spin-echo sequence (CS-SPACE) for knee 3-T magnetic resonance imaging with traditional 3D fast spin-echo (SPACE) and routine 2D sequences. Skeletal Radiol. 2016; 46(1):7-15. DOI: 10.1007/s00256-016-2490-8. View