Occult Intraosseous Fracture: Detection with MR Imaging

Magnetic resonance (MR) images were retrospectively evaluated in eight patients who had recent, symptomatic knee injuries and in whom plain radiographs showed no fractures. T2-weighted images revealed irregular, intraosseous areas of high signal intensity; T1-weighted and proton density images revealed speckled or linear regions of low signal intensity in corresponding areas. In the seven patients whose injuries did not result from direct contusion, abnormalities occurred in subchondral locations. Two patients underwent bone scintigraphy, which showed increased activity in locations corresponding to areas of abnormality noted on MR images. Two patients underwent follow-up MR imaging at 6 weeks and 3 months, which showed complete resolution of the abnormalities. The authors speculate that the MR imaging findings represent microscopic compression fracture of trabecular bone and discuss the related entity, stress fracture.